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Bleasel JM, Wan SS, Chadban SJ, Ying T, Gracey DM, Aouad LJ, Chen QA, Utsiwegota M, Mawson J, Wyburn KR. ABO Incompatible Kidney Transplantation Without B-cell Depletion is Associated With Increased Early Acute Rejection: A Single-Center Australian Experience. Transpl Int 2023; 36:11567. [PMID: 37799670 PMCID: PMC10547868 DOI: 10.3389/ti.2023.11567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023]
Abstract
We performed a single-center retrospective cohort study of 66 consecutive ABO incompatible kidney transplants (ABOiKT) performed without B-cell depleting therapy. Outcomes were compared to an earlier era performed with rituximab (n = 18) and a contemporaneous cohort of ABO compatible live donor transplants (ABOcKT). Acute rejection within 3 months of transplant was significantly more common after rituximab-free ABOiKT compared to ABOiKT with rituximab (OR 8.8, p = 0.04) and ABOcKT (OR 2.9, p = 0.005) in adjusted analyses. Six recipients of rituximab-free ABOiKT experienced refractory antibody mediated rejection requiring splenectomy, and a further two incurred early graft loss with no such episodes amongst ABOiKT with rituximab or ABOcKT cohorts. Patient and graft survival were similar between groups over a median follow-up of 3.1 years. This observational evidence lends strong support to the continued inclusion of rituximab in desensitization protocols for ABOiKT.
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Affiliation(s)
- Jonathan M. Bleasel
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Susan S. Wan
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Kidney Node, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Steven J. Chadban
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Kidney Node, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Tracey Ying
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Kidney Node, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - David M. Gracey
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Leyla J. Aouad
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Kidney Node, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Qian-Ao Chen
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Mike Utsiwegota
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jane Mawson
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kate R. Wyburn
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Kidney Node, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Waller KMJ, De La Mata NL, Wyburn KR, Hedley JA, Rosales BM, Kelly PJ, Ramachandran V, Shah KK, Morton RL, Rawlinson WD, Webster AC. Notifiable Infectious Diseases Among Organ Transplant Recipients: A Data-Linked Cohort Study, 2000–2015. Open Forum Infect Dis 2022; 9:ofac337. [PMID: 35937651 PMCID: PMC9348761 DOI: 10.1093/ofid/ofac337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 05/18/2022] [Indexed: 11/12/2022] Open
Abstract
Background Infections, including common communicable infections such as influenza, frequently cause disease after organ transplantation, although the quantitative extent of infection and disease remains uncertain. Methods A cohort study was conducted to define the burden of notifiable infectious diseases among all solid organ recipients transplanted in New South Wales, Australia, 2000–2015. Data linkage was used to connect transplant registers to hospital admissions, notifiable diseases, and the death register. Standardized incidence ratios (SIRs) were calculated relative to general population notification rates, accounting for age, sex, and calendar year. Infection-related hospitalizations and deaths were identified. Results Among 4858 solid organ recipients followed for 39 183 person-years (PY), there were 792 notifications. Influenza was the most common infection (532 cases; incidence, 1358 [95% CI, 1247–1478] per 100 000 PY), highest within 3 months posttransplant. Next most common was salmonellosis (46 cases; incidence, 117 [95% CI, 87–156] per 100 000 PY), then pertussis (38 cases; incidence, 97 [95% CI, 71–133] per 100 000 PY). Influenza and invasive pneumococcal disease (IPD) showed significant excess cases compared with the general population (influenza SIR, 8.5 [95% CI, 7.8–9.2]; IPD SIR, 9.8 [95% CI, 6.9–13.9]), with high hospitalization rates (47% influenza cases, 68% IPD cases) and some mortality (4 influenza and 1 IPD deaths). By 10 years posttransplant, cumulative incidence of any vaccine-preventable disease was 12%, generally similar by transplanted organ, except higher among lung recipients. Gastrointestinal diseases, tuberculosis, and legionellosis had excess cases among transplant recipients, although there were few sexually transmitted infections and vector-borne diseases. Conclusions There is potential to avoid preventable infections among transplant recipients with improved vaccination programs, health education, and pretransplant donor and recipient screening.
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Affiliation(s)
- Karen M J Waller
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Health and Medicine, University of Sydney , Sydney , Australia
| | - Nicole L De La Mata
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Health and Medicine, University of Sydney , Sydney , Australia
| | - Kate R Wyburn
- Department of Renal Medicine, Royal Prince Alfred Hospital , Camperdown , Australia
- Sydney Medical School, Faculty of Health and Medicine, University of Sydney , Sydney , Australia
| | - James A Hedley
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Health and Medicine, University of Sydney , Sydney , Australia
| | - Brenda M Rosales
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Health and Medicine, University of Sydney , Sydney , Australia
| | - Patrick J Kelly
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Health and Medicine, University of Sydney , Sydney , Australia
| | - Vidiya Ramachandran
- Serology and Virology Division, New South Wales Health Pathology Randwick Prince of Wales Hospital , Randwick , Australia
| | - Karan K Shah
- Clinical Trials Centre, University of Sydney National Health and Medical Research Council , Camperdown , Australia
| | - Rachael L Morton
- Clinical Trials Centre, University of Sydney National Health and Medical Research Council , Camperdown , Australia
| | - William D Rawlinson
- Serology and Virology Division, New South Wales Health Pathology Randwick Prince of Wales Hospital , Randwick , Australia
- School of Medical Sciences, School of Biotechnology and Biomolecular Sciences, and School of Women’s and Children’s Health, University of New South Wales , Sydney , Australia
| | - Angela C Webster
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Health and Medicine, University of Sydney , Sydney , Australia
- Clinical Trials Centre, University of Sydney National Health and Medical Research Council , Camperdown , Australia
- Centre for Transplant and Renal Research, Westmead Hospital , Sydney , Australia
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Waller KMJ, De La Mata NL, Rosales BM, Hedley JA, Kelly PJ, Thomson IK, O'Leary MJ, Cavazzoni E, Ramachandran V, Rawlinson WD, Wyburn KR, Webster AC. Characteristics and Donation Outcomes of Potential Organ Donors Perceived to Be at Increased Risk for Blood-borne Virus Transmission: An Australian Cohort Study 2010-2018. Transplantation 2022; 106:348-357. [PMID: 33988336 DOI: 10.1097/tp.0000000000003715] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Safely increasing organ donation to meet need is a priority. Potential donors may be declined because of perceived blood-borne virus (BBV) transmission risk. With hepatitis C (HCV) curative therapy, more potential donors may now be suitable. We sought to describe potential deceased donors with increased BBV transmission risk. METHODS We conducted a cohort study of all potential organ donors referred in NSW, Australia, 2010-2018. We compared baseline risk potential donors to potential donors with increased BBV transmission risk, due to history of HIV, HCV or hepatitis B, and/or behavioral risk factors. RESULTS There were 624 of 5749 potential donors (10.9%) perceived to have increased BBV transmission risk. This included 298 of 5749 (5.2%) with HCV (including HBV coinfections) and 239 of 5749 (4.2%) with increased risk behaviors (no known BBV). Potential donors with HCV and those with increased risk behaviors were younger and had fewer comorbidities than baseline risk potential donors (P < 0.001). Many potential donors (82 with HCV, 38 with risk behaviors) were declined for donation purely because of perceived BBV transmission risk. Most were excluded before BBV testing. When potential donors with HCV did donate, they donated fewer organs than baseline risk donors (median 1 versus 3, P < 0.01), especially kidneys (odds ratio 0.08, P < 0.001) and lungs (odds ratio 0.11, P = 0.006). CONCLUSIONS Many potential donors were not accepted because of perceived increased BBV transmission risk, without viral testing, and despite otherwise favorable characteristics. Transplantation could be increased from potential donors with HCV and/or increased risk behaviors.
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Affiliation(s)
- Karen M J Waller
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Health and Medicine, The University of Sydney, Camperdown, NSW, Australia
| | - Nicole L De La Mata
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Health and Medicine, The University of Sydney, Camperdown, NSW, Australia
| | - Brenda M Rosales
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Health and Medicine, The University of Sydney, Camperdown, NSW, Australia
| | - James A Hedley
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Health and Medicine, The University of Sydney, Camperdown, NSW, Australia
| | - Patrick J Kelly
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Health and Medicine, The University of Sydney, Camperdown, NSW, Australia
| | - Imogen K Thomson
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Health and Medicine, The University of Sydney, Camperdown, NSW, Australia
| | - Michael J O'Leary
- NSW Organ and Tissue Donation Service, Kogarah, NSW, Australia
- Intensive Care Service, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Elena Cavazzoni
- NSW Organ and Tissue Donation Service, Kogarah, NSW, Australia
| | - Vidiya Ramachandran
- Serology and Virology Division, NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - William D Rawlinson
- Serology and Virology Division, NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW, Australia
- Schools of SOMS, BABS and Women's and Children's, University of NSW, Randwick, NSW, Australia
| | - Kate R Wyburn
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Angela C Webster
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Health and Medicine, The University of Sydney, Camperdown, NSW, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
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Wyld ML, Wyburn KR, Chadban SJ. Global Perspective on Kidney Transplantation: Australia. Kidney360 2021; 2:1641-1644. [PMID: 35372973 PMCID: PMC8785793 DOI: 10.34067/kid.0003692021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/08/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Melanie L.R. Wyld
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
- Department of Renal and Transplant Medicine, Westmead Hospital, Westmead, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kate R. Wyburn
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Kidney Node, Charles Perkins Centre, University of Sydney, Australia
| | - Steve J. Chadban
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Kidney Node, Charles Perkins Centre, University of Sydney, Australia
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Waller KMJ, De La Mata NL, Wyburn KR, Kelly PJ, Ramachandran V, Shah K, Morton R, Rawlinson WD, Webster AC. Vaccine-Preventable Infections Among Solid Organ Transplant Recipients: A Data-Linked Cohort Study, Australia, 2000-2015. Int J Popul Data Sci 2020. [DOI: 10.23889/ijpds.v5i5.1643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
IntroductionRecipients of solid organ transplants are at risk of serious infection due to immunosuppression. Some infections are preventable with vaccination; infection rates vary with immunosuppression, vaccination rates and baseline disease prevalence. Both adherence with and response to vaccination in this population are variable, and optimum vaccination strategies continue to be refined.
Objectives and ApproachWe aimed to characterise the incidence and complications of vaccine-preventable infections in transplant recipients. Eligible participants received an organ transplant in New South Wales, Australia, in 2000-2015. Linkage was undertaken between transplant registries and the notifiable conditions information management system. Vaccine-preventable infections were diphtheria, Haemophilus influenzae type b, influenza, invasive pneumococcal disease, measles, mumps, pertussis, poliovirus, rubella and tetanus. Standardized incidence ratios (SIR) were calculated relative to Australian population notification rates, standardizing for gender, age and calendar year.
ResultsAmong 3,394 recipients, 399 vaccine-preventable infections affected 339 (10%) recipients. Influenza was the most common vaccine-preventable infection with 352 notifications among 305 recipients. Influenza cases were 8.9 times more common among transplant recipients than the general population (95%CI: 8.0-10.0). In 36 cases (10%), hospitalization was required, and 2 deaths due to influenza were reported.
There were 20 notifications of invasive pneumococcal disease (IPD) for 18 recipients. IPD occurred 10.2 times more often among transplant recipients than the general population (95%CI: 6.4-16.2). Most (n=13, 65%) cases were hospitalized, and one patient died from IPD.
Cases of pertussis occurred only slightly more often than in the general population (SIR 1.5, 95%CI: 1.0-2.3). Of 26 cases, there was one reported hospitalization and no deaths due to pertussis. Only one case of mumps, and no other vaccine-preventable infections, were reported.
ConclusionTransplant recipients have excess cases of influenza and IPD compared to the general population, although this has improved over time. The need for appropriate recipient vaccination is emphasized.
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Waller KMJ, De La Mata NL, Hedley JA, Rosales BM, O’Leary MJ, Cavazzoni E, Ramachandran V, Rawlinson WD, Kelly PJ, Wyburn KR, Webster AC. New Blood Borne Virus Infections Among Organ Transplant Recipients: A Data-Linked Cohort Study Examining Transmissions and De Novo Infections. Int J Popul Data Sci 2020. [DOI: 10.23889/ijpds.v5i5.1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
IntroductionSolid organ transplant recipients are at risk of infections, which may be either derived through transplantation or acquired later. Blood-borne viruses (BBV) are a particular concern for donor-derived transmissions. There is an increasing emphasis on biovigilance – monitoring the safety of donated organs. However, systematic surveillance to distinguish donor-transmitted infection from de novo post-transplant infection is challenging. Additional information can be obtained through linkage of administrative health data.
Objectives and ApproachWe aimed to identify donor-transmitted and de novo BBV infections among organ transplant recipients. We conducted a cohort study of all solid organ donor-recipient pairs in New South Wales, Australia, 2000-2015. Donor and recipient BBV infections were identified by linking transplant registries with administrative health data. Proven/probable donor-transmissions were identified among new recipient infections within 12 months of transplant, classified according to an international algorithm. All other new BBV infections were classified as de novo infections.
ResultsAmong 2,120 organ donors, 73 had a BBV infection (11/73 active, 62/73 past). Donors with BBV donated to 176 recipients, of whom 24/176 had the same BBV as their donor, and 152/176 did not; these 152 recipients were at risk of donor-transmission. Among those at risk, there were 3/152 proven/probable BBV transmissions (1 hepatitis C, 2 hepatitis B [HBV]) and 149/152 recipients with non-transmissions. All donor-transmissions were previously recognised by donation services, and were from donors with known BBV. There were no deaths from transmissions. There were 70 recipients with de novo BBV; 2/70 died from new HBV.
Conclusion / ImplicationsThis work confirms the safety of Australian organ donation, with no unrecognised BBV transmissions and many non-transmissions from donors with BBV. This may support increasing targeted donation from donors with BBV. However, de novo BBV infections were substantial and preventable. Data-linkage may be a useful adjunct to current biovigilance systems.
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Waller KMJ, De La Mata NL, Wyburn KR, Kelly PJ, Ramachandran V, Shah KK, Morton RL, Rawlinson WD, Webster AC. VACCINE-PREVENTABLE INFECTIONS AMONG SOLID ORGAN TRANSPLANT RECIPIENTS: A DATA-LINKED COHORT STUDY, AUSTRALIA, 2000-2015. Transplantation 2020. [DOI: 10.1097/01.tp.0000700100.35245.4a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Waller KMJ, De La Mata NL, Hedley JA, Rosales BM, O'Leary MJ, Cavazzoni E, Ramachandran V, Rawlinson WD, Kelly PJ, Wyburn KR, Webster AC. New blood-borne virus infections among organ transplant recipients: An Australian data-linked cohort study examining donor transmissions and other HIV, hepatitis C and hepatitis B notifications, 2000-2015. Transpl Infect Dis 2020; 22:e13437. [PMID: 32767859 DOI: 10.1111/tid.13437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/25/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Blood-borne viral infections can complicate organ transplantation. Systematic monitoring to distinguish donor-transmitted infections from other new infections post transplant is challenging. Administrative health data can be informative. We aimed to quantify post-transplant viral infections, specifically those transmitted by donors and those reactivating or arising new in recipients. METHODS We linked transplant registries with administrative health data for all solid organ donor-recipient pairs in New South Wales, Australia, 2000-2015. All new recipient notifications of hepatitis B (HBV), C (HCV), or human immunodeficiency virus (HIV) after transplant were identified. Proven/probable donor transmissions within 12 months of transplant were classified using an international algorithm. RESULTS Of 2120 organ donors, there were 72 with a viral infection (9/72 active, 63/72 past). These 72 donors donated to 173 recipients, of whom 24/173 already had the same infection as their donor, and 149/173 did not, so were at risk of donor transmission. Among those at risk, 3/149 recipients had proven/probable viral transmissions (1 HCV, 2 HBV); none were unrecognized by donation services. There were no deaths from transmissions. There were no donor transmissions from donors without known blood-borne viruses. An additional 68 recipients had new virus notifications, of whom 2/68 died, due to HBV infection. CONCLUSION This work confirms the safety of organ donation in an Australian cohort, with no unrecognized viral transmissions and most donors with viral infections not transmitting the virus. This may support targeted increases in donation from donors with viral infections. However, other new virus notifications post transplant were substantial and are preventable. Data linkage can enhance current biovigilance systems.
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Affiliation(s)
- Karen M J Waller
- Faculty of Health and Medicine, Sydney School of Public Health, Centre for Organ Donation Evidence, University of Sydney, Sydney, NSW, Australia
| | - Nicole L De La Mata
- Faculty of Health and Medicine, Sydney School of Public Health, Centre for Organ Donation Evidence, University of Sydney, Sydney, NSW, Australia
| | - James A Hedley
- Faculty of Health and Medicine, Sydney School of Public Health, Centre for Organ Donation Evidence, University of Sydney, Sydney, NSW, Australia
| | - Brenda M Rosales
- Faculty of Health and Medicine, Sydney School of Public Health, Centre for Organ Donation Evidence, University of Sydney, Sydney, NSW, Australia.,Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Michael J O'Leary
- New South Wales Organ and Tissue Donation Service, Sydney, NSW, Australia.,Department of Intensive Care Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Elena Cavazzoni
- New South Wales Organ and Tissue Donation Service, Sydney, NSW, Australia
| | - Vidiya Ramachandran
- Serology and Virology Division, NSW Health Pathology Randwick Prince of Wales Hospital, Randwick, NSW, Australia
| | - William D Rawlinson
- Serology and Virology Division, NSW Health Pathology Randwick Prince of Wales Hospital, Randwick, NSW, Australia.,Schools of SOMS, BABS and Women's and Children's, University of NSW, Kensington, NSW, Australia
| | - Patrick J Kelly
- Faculty of Health and Medicine, Sydney School of Public Health, Centre for Organ Donation Evidence, University of Sydney, Sydney, NSW, Australia
| | - Kate R Wyburn
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Faculty of Health and Medicine, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Angela C Webster
- Faculty of Health and Medicine, Sydney School of Public Health, Centre for Organ Donation Evidence, University of Sydney, Sydney, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
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Waller KMJ, Hedley JA, Rosales BM, De La Mata NL, Thomson IK, Walker J, Kelly PJ, O'Leary MJ, Cavazzoni E, Wyburn KR, Webster AC. Effect of language and country of birth on the consent process and medical suitability of potential organ donors; a linked-data cohort study 2010-2015. J Crit Care 2020; 57:23-29. [PMID: 32014644 DOI: 10.1016/j.jcrc.2020.01.025] [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: 10/29/2019] [Revised: 12/02/2019] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Australia has unmet need for transplantation. We sought to assess the impact of cultural and linguistic diversity (CALD) on family consent and medical suitability for organ donation. METHOD Cohort study of New South Wales donor referrals, 2010-2015. Logistic regression estimated effects of primary language other than English and birthplace outside Australia (odds ratios OR, with 95% confidence intervals, 95%CI). Outcomes were whether families were asked for consent to donation, provided consent for donation, and whether the referral was medically suitable for donation. RESULTS Of 2977 organ donor referrals, a similar proportion of families had consent for donation was sought between non-English speakers and English speakers (p = .07), and between overseas-born compared to Australian-born referrals (p = .3). However, consent was less likely to be given for both non-English speakers than English speakers (OR 0.44, 95%CI:0.29-0.67), and those overseas-born than Australian-born (OR 0.54, 95%CI:0.41-0.72). For referrals both overseas-born and non-English speaking, families were both less likely to be asked for consent (OR 0.67; 95%CI:0.49-0.91) or give consent (OR 0.24; 95%CI0.16-0.37). There was no difference in medical suitability between English speakers and non-English speakers (p = .6), or between Australian-born and overseas-born referrals (p = .6). CONCLUSION Intervention to improve consent rates from CALD families may increase donation.
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Affiliation(s)
- Karen M J Waller
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - James A Hedley
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Brenda M Rosales
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Nicole L De La Mata
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Imogen K Thomson
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - John Walker
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Economics, Faculty of Arts and Social Sciences, University of Sydney, Sydney, Australia.
| | - Patrick J Kelly
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Michael J O'Leary
- New South Wales Organ and Tissue Donation Service, Sydney, Australia.
| | - Elena Cavazzoni
- New South Wales Organ and Tissue Donation Service, Sydney, Australia.
| | - Kate R Wyburn
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Renal Department, Royal Prince Alfred Hospital, Sydney, Australia.
| | - Angela C Webster
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia.
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Waller KM, De La Mata NL, Kelly PJ, Ramachandran V, Rawlinson WD, Wyburn KR, Webster AC. Residual risk of infection with blood-borne viruses in potential organ donors at increased risk of infection: systematic review and meta-analysis. Med J Aust 2019; 211:414-420. [PMID: 31489635 DOI: 10.5694/mja2.50315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/15/2019] [Accepted: 06/06/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To estimate the prevalence and incidence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) among people at increased risk of infection in Australia; to estimate the residual risk of infection among potential solid organ donors in these groups when their antibody and nucleic acid test results are negative. STUDY DESIGN Systematic review and meta-analysis of reports of the incidence and prevalence of HIV, HCV, and HBV in groups at increased risk of infection in Australia. DATA SOURCES MEDLINE, government and agency reports, Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine conference abstracts, the Australian New Zealand Clinical Trial Registry, and National Health and Medical Research Council grants published 1 January 2000 - 14 February 2019; personal communications. DATA SYNTHESIS Residual risk of HIV infection was highest among men who have sex with men (4.8 [95% CI, 2.7-6.9] per 10 000 antibody-negative persons; 1.5 [95% CI, 0.9-2.2] per 10 000 persons who are both antibody- and nucleic acid-negative). Residual risk of HCV infection was highest among injecting drug users (289 [95% CI, 191-385] per 10 000 antibody-negative persons; 20.9 [95% CI, 13.8-28.0] per 10 000 antibody- and nucleic acid-negative persons). Residual risk for HBV infection was highest among injecting drug users (98.6 [95% CI, 36.4-213] per 10 000 antibody-negative people; 49.4 [95% CI, 18.2-107] per 10 000 persons who were also nucleic acid-negative). CONCLUSIONS Absolute risks of window period viral infections are low in people from Australian groups at increased risk but with negative viral test results. Accepting organ donations by people at increased risk of infection but with negative viral test results could be considered as a strategy for expanding the donor pool. REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO), CRD42017069820.
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Affiliation(s)
| | | | | | - Vidiya Ramachandran
- NSW Health Pathology, Prince of Wales Hospital and Community Health Services, Sydney, NSW
| | - William D Rawlinson
- NSW Health Pathology, Prince of Wales Hospital and Community Health Services, Sydney, NSW.,University of New South Wales, Sydney, NSW
| | - Kate R Wyburn
- Royal Prince Alfred Hospital, Sydney, NSW.,Sydney Medical School, University of Sydney, Sydney, NSW
| | - Angela C Webster
- University of Sydney, Sydney, NSW.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW
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Wyburn KR, Chadban SJ, Kwan T, Alexander SI, Wu H. Interleukin-18 binding protein therapy is protective in adriamycin nephropathy. Am J Physiol Renal Physiol 2012; 304:F68-76. [PMID: 23097468 DOI: 10.1152/ajprenal.00669.2011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Adriamycin nephropathy (AN) is an experimental model of focal segmental glomerulosclerosis (FSGS) in which macrophages are considered to play a pathogenic role. We hypothesize that interleukin-18 (IL-18), largely derived from macrophages, is a key contributor to kidney injury in AN and a potential therapeutic target. In this study, BALB/c mice received adriamycin (9.6 mg/kg) via tail vein injection and subsequently were treated with either neutralizing IL-18 binding protein (IL-18BP; 250 μg) or normal saline (control). At 5 wk, IL-18 was upregulated in AN, and IL-18BP therapy afforded significant protection against the development of AN, resulting in less proteinuria (P < 0.01), kidney dysfunction (P < 0.01), glomerulosclerosis (P < 0.001), and interstitial accumulation of macrophages and T cells (P < 0.001). Gene expression of IL-18 downstream inflammatory molecules, including inducible nitric oxide synthase (P < 0.001), TNF-α (P < 0.001), and IFN-γ (P < 0.01); IL-17 (P < 0.001) and the chemokines CCL2 (P < 0.01) and CCL5 (P < 0.005), was reduced. We demonstrate that IL-18 plays a significant role in the pathogenesis of AN. The protective effect of IL-18BP therapy illustrates the importance of immune mediators in chronic proteinuric kidney disease and highlights the potential of IL-18BP therapy.
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Affiliation(s)
- Kate R Wyburn
- Collaborative Transplant Research Group, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.
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12
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Chadban SJ, Barraclough KA, Campbell SB, Clark CJ, Coates PT, Cohney SJ, Cross NB, Eris JM, Henderson L, Howell MR, Isbel NM, Kanellis J, Kotwal SS, Manley P, Masterson R, Mulley W, Murali K, O'Connell P, Pilmore H, Rogers N, Russ GR, Walker RG, Webster AC, Wiggins KJ, Wong G, Wyburn KR. KHA-CARI guideline: KHA-CARI adaptation of the KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients. Nephrology (Carlton) 2012; 17:204-14. [PMID: 22212251 DOI: 10.1111/j.1440-1797.2011.01559.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Steven J Chadban
- Transplantation and Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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13
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Wang Y, Sebaratnam DF, Wong JCH, Cooper W, Wyburn KR, Eris JM. URETHRAL STRICTURE CAUSED BY SCHISTOSOMIASIS IN A RENAL TRANSPLANT RECIPIENT. Nephrology (Carlton) 2012; 17:197-8. [DOI: 10.1111/j.1440-1797.2011.01516.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wu H, Ma J, Wang P, Corpuz TM, Panchapakesan U, Wyburn KR, Chadban SJ. HMGB1 contributes to kidney ischemia reperfusion injury. J Am Soc Nephrol 2010; 21:1878-90. [PMID: 20847143 DOI: 10.1681/asn.2009101048] [Citation(s) in RCA: 266] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
High-mobility group box 1 (HMGB1), a nuclear factor released extracellularly as an inflammatory cytokine, is an endogenous ligand for Toll-like receptor 4 (TLR4). TLR4 activation mediates kidney ischemia-reperfusion injury (IRI), but whether HMGB1 contributes to IRI is unknown. Here, treating wild-type mice with neutralizing anti-HMGB1 antibody protected them against kidney IRI, evidenced by lower serum creatinine and less tubular damage than untreated mice. Mice treated with anti-HMGB1 had significantly less tubulointerstitial infiltration by neutrophils (day 1) and macrophages (day 5) and markedly reduced apoptosis of tubular epithelial cells. Furthermore, anti-HMGB1 antibody-treated IRI kidneys had significantly lower levels of IL-6, TNFα, and monocyte chemoattractant protein 1 (MCP1). mRNA, which are downstream of HMGB1. Conversely, administration of rHMGB1 after reperfusion exacerbated kidney IRI in wild-type mice. TLR4 deficient (TLR4(-/-)) mice were protected against kidney IRI; administration of neither anti-HMGB1 antibody nor rHMGB1 affected this renoprotection. In conclusion, endogenous HMGB1 promotes kidney damage after IRI, possibly through the TLR4 pathway. Administration of a neutralizing antibody to HMGB1 either before or soon after ischemia-reperfusion affords significant protection, suggesting therapeutic potential for acute kidney injury.
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Affiliation(s)
- Huiling Wu
- Collaborative Transplant Research Group, Royal Prince Alfred Hospital, Sydney, Australia.
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15
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Abstract
BACKGROUND Photopheresis is an immunomodulatory therapy for the treatment of T cell-mediated disorders. It has been used for rejection prophylaxis in cardiac transplantation, adjuvant treatment of bronchiolitis obliterans in lung transplantation, treatment of graft verse host disease, and in a small number of cases, for treatment of acute rejection in renal transplantation. Little is known of long-term outcomes following the use of photopheresis in solid organ transplantation. METHODS We report prospective follow-up of our consecutive experience of the use of photopheresis as adjuvant/salvage therapy for problematic rejection in patients undergoing renal transplantation. Transplant graft survival, infective and malignant outcomes were reported. RESULTS A cohort of 10 renal transplants recipients received photopheresis therapy for therapy-resistant rejection. Conventional therapy included an average of 6.2 g pulse methyl-prednisolone and 17.1 days antilymphocyte therapy. The cohort received additional photopheresis therapy when the unresponsive nature of their rejections raised concerns of graft loss. Median follow-up censored for patient loss was 66.7 months following photopheresis commencement. Rejection resolved in association with photopheresis use in all 10 patients. Six patients continued to have stable graft function (median serum creatinine: 191.5 micromol/L) at a median follow-up of 71.0 months. There has been one patient death from sepsis and two from malignancy with functioning grafts while one graft has been lost to disease recurrence. CONCLUSION Photopheresis may have a role as an adjuvant or salvage antirejection therapy in solid organ transplantation. Furthermore, evaluation in randomized controlled clinical trials is required to evaluate its potential.
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Affiliation(s)
- Meg J Jardine
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
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Wu H, Craft ML, Wang P, Wyburn KR, Chen G, Ma J, Hambly B, Chadban SJ. IL-18 contributes to renal damage after ischemia-reperfusion. J Am Soc Nephrol 2008; 19:2331-41. [PMID: 18815244 DOI: 10.1681/asn.2008020170] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IL-18 is a proinflammatory cytokine produced by macrophages and other cell types present in the kidney during ischemia-reperfusion injury (IRI), but its role in this injury is unknown. Here, compared with wild-type mice, IL-18(-/-) mice subjected to kidney IRI demonstrated better kidney function, less tubular damage, reduced accumulation of neutrophils and macrophages, and decreased expression of proinflammatory molecules that are downstream of IL-18. For determination of the relative contributions of leukocytes and parenchymal cells to IL-18 production and subsequent kidney damage during IRI, bone marrow-chimeric mice were generated. Wild-type mice engrafted with IL-18(-/-) hemopoietic cells showed less kidney dysfunction and tubular damage than IL-18(-/-) mice engrafted with wild-type bone marrow. In vitro, macrophages produced IL-18 mRNA and protein in response to ischemia. These data suggest bone marrow-derived cells are the key contributors to IL-18-mediated effects of renal IRI. Finally, similar to IL-18(-/-) mice, pretreatment of wild-type mice with IL-18-binding protein was renoprotective in this model of IRI. In conclusion, IL-18, derived primarily from cells of bone marrow origin, contributes to the renal damage observed during IRI. IL-18-binding protein may have potential as a renoprotective therapy.
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Affiliation(s)
- Huiling Wu
- Collaborative Transplant Research Group, Renal Medicine, Royal Prince Alfred Hospital and Bosch Institute, Faculty of Medicine, University of Sydney, Sydney, Australia.
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Wu H, Chen G, Wyburn KR, Yin J, Bertolino P, Eris JM, Alexander SI, Sharland AF, Chadban SJ. TLR4 activation mediates kidney ischemia/reperfusion injury. J Clin Invest 2007; 117:2847-59. [PMID: 17853945 PMCID: PMC1974864 DOI: 10.1172/jci31008] [Citation(s) in RCA: 647] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Accepted: 06/28/2007] [Indexed: 12/26/2022] Open
Abstract
Ischemia/reperfusion injury (IRI) may activate innate immunity through the engagement of TLRs by endogenous ligands. TLR4 expressed within the kidney is a potential mediator of innate activation and inflammation. Using a mouse model of kidney IRI, we demonstrated a significant increase in TLR4 expression by tubular epithelial cells (TECs) and infiltrating leukocytes within the kidney following ischemia. TLR4 signaling through the MyD88-dependent pathway was required for the full development of kidney IRI, as both TLR4(-/-) and MyD88(-/-) mice were protected against kidney dysfunction, tubular damage, neutrophil and macrophage accumulation, and expression of proinflammatory cytokines and chemokines. In vitro, WT kidney TECs produced proinflammatory cytokines and chemokines and underwent apoptosis after ischemia. These effects were attenuated in TLR4(-/-) and MyD88(-/-) TECs. In addition, we demonstrated upregulation of the endogenous ligands high-mobility group box 1 (HMGB1), hyaluronan, and biglycan, providing circumstantial evidence that one or more of these ligands may be the source of TLR4 activation. To determine the relative contribution of TLR4 expression by parenchymal cells or leukocytes to kidney damage during IRI, we generated chimeric mice. TLR4(-/-) mice engrafted with WT hematopoietic cells had significantly lower serum creatinine and less tubular damage than WT mice reconstituted with TLR4(-/-) BM, suggesting that TLR4 signaling in intrinsic kidney cells plays the dominant role in mediating kidney damage.
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Affiliation(s)
- Huiling Wu
- Collaborative Transplant Research Group, Royal Prince Alfred Hospital and Bosch Institute, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.
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Abstract
Macrophage accumulation has long been recognized as a feature of allograft rejection, yet the role of macrophages in rejection remains underappreciated. Macrophages contribute to both the innate and acquired arms of the alloimmune response and thus may be involved in all aspects of acute and chronic allograft rejection. Recent advances in macrophage biology have allowed a better understanding of the mechanisms of macrophage accumulation, their state of activation and the pleuripotent roles they play in allograft rejection. Therapeutic attention to macrophages, in addition to T lymphocytes, may lead to improved outcomes in organ transplantation.
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Affiliation(s)
- Kate R Wyburn
- Department of Transplantation, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
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Wyburn KR, Horvath JS. Chronic renal insufficiency and renoprotective strategies. Intern Med J 2003; 33:237-41. [PMID: 12752894 DOI: 10.1046/j.1445-5994.2003.00388.x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The increasing incidence in the number of patients with end-stage renal disease is a major public health and economic concern. There is growing awareness that early detection and intervention can have a significant impact on delaying the progression of chronic renal insufficiency and the associated comorbidities. By implementing renoprotective measures early, even modest improvements can equate to significant benefits in the long term, hence the importance of identifying at-risk patients and early referrals to specialist multidisciplinary teams. In this review, some of the evidence-based renoprotective measures available are examined.
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Affiliation(s)
- K R Wyburn
- Department of Renal Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia.
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Gobé GC, Buttyan R, Wyburn KR, Etheridge MR, Smith PJ. Clusterin expression and apoptosis in tissue remodeling associated with renal regeneration. Kidney Int 1995; 47:411-20. [PMID: 7723230 DOI: 10.1038/ki.1995.54] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [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: 01/26/2023]
Abstract
To analyze the role of clusterin in renal diseases involving a regenerative process, we have used a novel rodent model to compare temporal and spatial expression of clusterin mRNA. Thus, renal artery stenosis was used to induce unilateral non-infarctive renal atrophy. After several weeks, when cellular pathology of atrophic kidneys involved minimal apoptosis or inflammatory response and mitosis was at normal levels, regeneration of atrophic kidneys was stimulated by removal of the contralateral healthy kidneys. The regrowth response was very rapid and involved renal hyperplasia rather than hypertrophy. Regenerating kidneys were studied 0, 4, 8, 24 hours and 2, 3, 5, 7, and 14 days after contralateral nephrectomy. Several parameters were compared: level and localization of clusterin mRNA; cell proliferation; cell dedifferentiation and redifferentiation and apoptosis. During the acute regenerative phase (first 24 hr) clusterin expression was markedly increased, decreasing to untraceable levels by five days of regeneration. Clusterin mRNA was localized in dilated or collapsed atrophic tubules that had lost identifying surface structures of normal tubular epithelium (termed dedifferentiated). Clusterin was also localized in the periphery of some blood vessel walls. Cell proliferation peaked at three to five days of regeneration, and was also localized in dedifferentiated tubules. Despite the regenerative stimulus, an unexpected result was a transient but marked increase in apoptotic cell death in atrophic tubules in the first 24 hours of regeneration. Our results provide evidence of a temporal association between increased clusterin expression and apoptosis, but in situ localization showed clusterin mRNA over apparently viable, as well as apoptotic, cells in the epithelium of tubules showing clusterin expression. Clusterin mRNA was rarely identified over epithelial cells in foci of non-atrophic (non-dedifferentiated) nephrons that responded to the regenerative stimulus by cellular hypertrophy. The dramatic response after initiation of regeneration, especially the initiation of apoptosis in the tubular epithelium, may have applications for the study of genetic changes leading to renal oncogenesis.
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Affiliation(s)
- G C Gobé
- Department of Pathology, University of Queensland Medical School, Brisbane, Australia
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