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Streichart L, Felldin M, Ekberg J, Mjörnstedt L, Lindnér P, Lennerling A, Bröcker V, Mölne J, Holgersson J, Daenen K, Wennberg L, Lorant T, Baid-Agrawal S. Tocilizumab in chronic active antibody-mediated rejection: rationale and protocol of an in-progress randomized controlled open-label multi-center trial (INTERCEPT study). Trials 2024; 25:213. [PMID: 38519988 PMCID: PMC10958896 DOI: 10.1186/s13063-024-08020-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/26/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Chronic active antibody-mediated rejection (caAMR) in kidney transplants is associated with irreversible tissue damage and a leading cause of graft loss in the long-term. However, the treatment for caAMR remains a challenge to date. Recently, tocilizumab, a recombinant humanized monoclonal antibody directed against the human interleukin-6 (IL-6) receptor, has shown promise in the treatment of caAMR. However, it has not been systematically investigated so far underscoring the need for randomized controlled studies in this area. METHODS The INTERCEPT study is an investigator-driven randomized controlled open-label multi-center trial in kidney transplant recipients to assess the efficacy of tocilizumab in the treatment of biopsy-proven caAMR. A total of 50 recipients with biopsy-proven caAMR at least 12 months after transplantation will be randomized to receive either tocilizumab (n = 25) added to our standard of care (SOC) maintenance treatment or SOC alone (n = 25) for a period of 24 months. Patients will be followed for an additional 12 months after cessation of study medication. After the inclusion biopsies at baseline, protocol kidney graft biopsies will be performed at 12 and 24 months. The sample size calculation assumed a difference of 5 ml/year in slope of estimated glomerular filtration rate (eGFR) between the two groups for 80% power at an alpha of 0.05. The primary endpoint is the slope of eGFR at 24 months after start of treatment. The secondary endpoints include assessment of the following at 12, 24, and 36 months: composite risk score iBox, safety, evolution and characteristics of donor-specific antibodies (DSA), graft histology, proteinuria, kidney function assessed by measured GFR (mGFR), patient- and death-censored graft survival, and patient-reported outcomes that include transplant-specific well-being, adherence to immunosuppressive medications and perceived threat of the risk of graft rejection. DISCUSSION No effective treatment exists for caAMR at present. Based on the hypothesis that inhibition of IL-6 receptor by tocilizumab will reduce antibody production and reduce antibody-mediated damage, our randomized trial has a potential to provide evidence for a novel treatment strategy for caAMR, therewith slowing the decline in graft function in the long-term. TRIAL REGISTRATION ClinicalTrials.gov NCT04561986. Registered on September 24, 2020.
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Affiliation(s)
- Lillian Streichart
- Transplant Institute, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Marie Felldin
- Transplant Institute, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Jana Ekberg
- Transplant Institute, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Lars Mjörnstedt
- Transplant Institute, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Per Lindnér
- Transplant Institute, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Annette Lennerling
- Transplant Institute, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Verena Bröcker
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Mölne
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Holgersson
- Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristien Daenen
- Department of Nephrology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Wennberg
- Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Lorant
- Section of Transplantation Surgery, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Seema Baid-Agrawal
- Transplant Institute, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden.
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Pettersson L, Westerling S, Talla V, Sendel A, Wennberg L, Olsson R, Hedrum A, Hauzenberger D. Development and performance of a next generation sequencing (NGS) assay for monitoring of dd-cfDNA post solid organ transplantation. Clin Chim Acta 2024; 552:117647. [PMID: 37951377 DOI: 10.1016/j.cca.2023.117647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023]
Abstract
The aim of this study was to evaluate the analytical performance of a novel NGS assay, intended for monitoring of donor-derived cell-free DNA (dd-cfDNA), and describe its validity in clinical plasma samples from kidney transplanted patients. Artificial and clinical samples with increasing amounts of patient DNA were evaluated using NGS analysis of indel markers. Monitoring of dd-cfDNA with the NGS assay presented herein demonstrated a sensitivity of ≥0.1% dd-cfDNA and excellent accuracy (R2 0.99) throughout an extensive range of dd-cfDNA (0.1-30%). The precision of the test was determined for two levels (0.1% (LoD) and 1%) of dd-cfDNA. The between run precision (CV%) for the respective level was 16% and 9% and the corresponding result for the within run precision was 19% and 7%. To evaluate performance of the assay in clinical samples, 507 retrospective monitoring samples from 21 patients transplanted either with kidneys from living or deceased donors were analyzed. Monitoring samples were sampled at multiple time points from 24 h up to 90 days post-transplantation. We show that in one patient, increase of dd-cfDNA preceded increase of creatinine caused by acute cellular rejection by several days. In conclusion, the NGS assay displayed a combination of high sensitivity with good accuracy and precision in both artificial and clinical dd-cfDNA samples.
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Affiliation(s)
| | | | - Venkat Talla
- Devyser AB, Instrumentvägen 19, SE-12653 Stockholm, Sweden
| | - Anton Sendel
- Dept. Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Wennberg
- Clinic for Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Richard Olsson
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Anders Hedrum
- Devyser AB, Instrumentvägen 19, SE-12653 Stockholm, Sweden
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Wennberg L, Mårtensson J, Langensee L, Sundgren PC, Markenroth Bloch K, Hansson B. Effects of ultra-high field MRI environment on cognitive performance in healthy participants. Radiography (Lond) 2024; 30:95-99. [PMID: 37879122 DOI: 10.1016/j.radi.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/14/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Ultra-high field MRI (UHF MRI) is rapidly becoming an essential part of our toolbox within health care and research studies; therefore, we need to get a deeper understanding of the physiological effects of ultra-high field. This study aims to investigate the cognitive performance of healthy participants in a 7 T (T) MRI environment in connection with subjectively experienced effects. METHODS We measured cognitive performance before and after a 1-h 7T MRI scanning session using a Digit Symbol Substitution Test (DSST) in 42 subjects. Furthermore, a computer-based survey regarding the subjectively experienced effects in connection with the MRI examination was distributed. Similarly, two DSSTs were also performed by a control group of 40 participants. RESULTS Even though dizziness was the strongest sensory perception in connection to the MRI scanning, we did not find any correlation between dizziness and cognitive performance. Whilst the control group improved (p=<0.001) on their second DSST the MRI group showed no significant difference (p=0.741) in the DSST before and after MRI scanning. CONCLUSION Transient effect on cognition after undergoing MRI scanning can't be ruled out as the expected learning effect on the DSST was not observed. IMPLICATIONS FOR PRACTICE Increasing understanding of the possible adverse effects may guide operators in performing UHF MRI in a safe way and with person-centered care. Furthermore, it can guide researchers in setting up research protocols to minimize confounding factors in their fMRI studies due to the transient adverse effects of the UHF environment.
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Affiliation(s)
- L Wennberg
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund/ Diagnostic Radiology, Faculty of Medicine, Lund University, Lund, Sweden.
| | - J Mårtensson
- Department of Clinical Sciences Lund/Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - L Langensee
- Department of Clinical Sciences Lund/Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - P C Sundgren
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund/ Diagnostic Radiology, Faculty of Medicine, Lund University, Lund, Sweden; Lund BioImaging Centre, Faculty of Medicine, Lund University, Lund, Sweden
| | - K Markenroth Bloch
- Lund BioImaging Centre, Faculty of Medicine, Lund University, Lund, Sweden
| | - B Hansson
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund/ Diagnostic Radiology, Faculty of Medicine, Lund University, Lund, Sweden
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4
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Hobson S, Qureshi AR, Ripswedan J, Wennberg L, de Loor H, Ebert T, Söderberg M, Evenepoel P, Stenvinkel P, Kublickiene K. Phenylacetylglutamine and trimethylamine N-oxide: Two uremic players, different actions. Eur J Clin Invest 2023; 53:e14074. [PMID: 37548021 PMCID: PMC10909455 DOI: 10.1111/eci.14074] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) patients exhibit a heightened cardiovascular (CV) risk which may be partially explained by increased medial vascular calcification. Although gut-derived uremic toxin trimethylamine N-oxide (TMAO) is associated with calcium-phosphate deposition, studies investigating phenylacetylglutamine's (PAG) pro-calcifying potential are missing. METHODS The effect of TMAO and PAG in vascular calcification was investigated using 120 kidney failure patients undergoing living-donor kidney transplantation (LD-KTx), in an observational, cross-sectional manner. Uremic toxin concentrations were related to coronary artery calcification (CAC) score, epigastric artery calcification score, and markers of established non-traditional risk factors that constitute to the 'perfect storm' that drives early vascular aging in this patient population. Vascular smooth muscle cells were incubated with TMAO or PAG to determine their calcifying effects in vitro and analyse associated pathways by which these toxins may promote vascular calcification. RESULTS TMAO, but not PAG, was independently associated with CAC score after adjustment for CKD-related risk factors in kidney failure patients. Neither toxin was associated with epigastric artery calcification score; however, PAG was independently, positively associated with 8-hydroxydeoxyguanosine. Similarly, TMAO, but not PAG, promoted calcium-phosphate deposition in vitro, while both uremic solutes induced oxidative stress. CONCLUSIONS In conclusion, our translational data confirm TMAO's pro-calcifying effects, but both toxins induced free radical production detrimental to vascular maintenance. Our findings suggest these gut-derived uremic toxins have different actions on the vessel wall and therapeutically targeting TMAO may help reduce CV-related mortality in CKD.
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Affiliation(s)
- Sam Hobson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Abdul Rashid Qureshi
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Jonaz Ripswedan
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
- Unit of radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lars Wennberg
- Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Henriette de Loor
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Thomas Ebert
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Magnus Söderberg
- Pathology, Clinical Pharmacology and Safety Sciences, R&D AstraZeneca, Gothenburg, Sweden
| | - Pieter Evenepoel
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Duus Weinreich I, Andersson T, Birna Andrésdóttir M, Bengtsson M, Biglarnia A, Bistrup C, Boulland L, Bruunsgaard H, Helanterä I, Kölvald K, Lauronen J, Lindahl JP, Skov K, Schwarz Sørensen S, Wennberg L, Lindner P. Scandiatransplant Exchange Program (STEP): Development and Results From an International Kidney Exchange Program. Transplant Direct 2023; 9:e1549. [PMID: 37854025 PMCID: PMC10581625 DOI: 10.1097/txd.0000000000001549] [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: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023] Open
Abstract
Background Kidney transplant candidates may be incompatible with their intended living donors because of the presence of antibodies against HLA and/or ABO. To increase the possibility of finding an acceptable kidney donor for these patients, the Scandiatransplant Exchange Program (STEP) program within Scandiatransplant was launched in 2019. Methods This is a retrospective review of our experiences from the first 4 y of the STEP program, including details about the match runs, performed transplantations, and recipient outcomes within the program. Results During 2019-2022, 11 match runs and 4 reruns were performed. In total, 114 pairs and 6 anonymous donors participated in these match runs. Fifty-one pairs (45%) participated in 1 match run, 31 pairs (27%) participated in 2 match runs, and 32 pairs (29%) participated in ≥3 match runs. Seventy-two individuals (63%) participated because of HLA incompatibility, 19 (17%) because of ABO incompatibility, and 7 (6%) because of both HLA and ABO incompatibility.Forty percent of the patients enrolled in the program underwent transplantation. In total, 49 transplantations have so far been performed within the program, and 46 (94%) of the recipients had a functioning kidney graft at follow-up in February 2023. Conclusions The STEP program offers sensitized patients an enlarged pool of living donors and a chance of a compatible international living donor, resulting in an increased number of total transplantations. Currently, STEP is one of the largest transnational kidney exchange programs and has improved the situation for patients waiting for kidney transplantation in Scandiatransplant.
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Affiliation(s)
| | | | | | - Mats Bengtsson
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Claus Bistrup
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Line Boulland
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway
| | - Helle Bruunsgaard
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ilkka Helanterä
- Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Kulli Kölvald
- Department of Nephrology, Tartu University Hospital, Tartu, Estonia
| | | | | | - Karin Skov
- Department of Renal Medicine, Aarhus University Hospital, Denmark
| | - Søren Schwarz Sørensen
- Department of Nephrology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Wennberg
- Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Per Lindner
- Transplantation Centre, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Hernandez L, Ward LJ, Arefin S, Barany P, Wennberg L, Söderberg M, Bruno S, Cantaluppi V, Stenvinkel P, Kublickiene K. Blood–Brain Barrier Biomarkers before and after Kidney Transplantation. Int J Mol Sci 2023; 24:ijms24076628. [PMID: 37047601 PMCID: PMC10095132 DOI: 10.3390/ijms24076628] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Kidney transplantation (KT) may improve the neurological status of chronic kidney disease (CKD) patients, reflected by the altered levels of circulating BBB-specific biomarkers. This study compares the levels of neuron specific enolase (NSE), brain-derived neurotrophic factor (BDNF), neurofilament light chain (NfL), and circulating plasma extracellular vesicles (EVs) in kidney-failure patients before KT and at a two-year follow up. Using ELISA, NSE, BDNF, and NfL levels were measured in the plasma of 74 living-donor KT patients. Plasma EVs were isolated with ultracentrifugation, and characterized for concentration/size and surface protein expression using flow cytometry from a subset of 25 patients. Lower NSE levels, and higher BDNF and NfL were observed at the two-year follow-up compared to the baseline (p < 0.05). Male patients had significantly higher BDNF levels compared to those of females. BBB biomarkers correlated with the baseline lipid profile and with glucose, vitamin D, and inflammation markers after KT. BBB surrogate marker changes in the microcirculation of early vascular aging phenotype patients with calcification and/or fibrosis were observed only in NSE and BDNF. CD31+ microparticles from endothelial cells expressing inflammatory markers such as CD40 and integrins were significantly reduced after KT. KT may, thus, improve the neurological status of CKD patients, as reflected by changes in BBB-specific biomarkers.
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Affiliation(s)
- Leah Hernandez
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Liam J. Ward
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, 587 58 Linköping, Sweden
| | - Samsul Arefin
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Peter Barany
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Lars Wennberg
- Department of Transplantation Surgery, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Magnus Söderberg
- Department of Pathology, Clinical Pharmacology and Safety Sciences, R&D AstraZeneca, 431 83 Gothenburg, Sweden
| | - Stefania Bruno
- Department of Medical Sciences, University of Torino, 10124 Torino, Italy
| | - Vincenzo Cantaluppi
- Nephrology and Kidney Transplant Unit, Department of Translational Medicine (DIMET), University of Piemonte Orientale (UPO), “Maggiore della Carita” University Hospital, 28100 Novara, Italy
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 171 77 Stockholm, Sweden
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Weinreich I, Bengtsson M, Lauronen J, Naper C, Lokk K, Helanterä I, Andrésdóttir MB, Sørensen SS, Wennberg L, Reisaeter AV, Møller B, Koefoed-Nielsen P. Scandiatransplant acceptable mismatch program-10 years with an effective strategy for transplanting highly sensitized patients. Am J Transplant 2022; 22:2869-2879. [PMID: 36030513 PMCID: PMC10087587 DOI: 10.1111/ajt.17182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 03/25/2022] [Revised: 07/27/2022] [Accepted: 08/21/2022] [Indexed: 01/25/2023]
Abstract
In March 2009, the Scandiatransplant acceptable mismatch program (STAMP) was introduced as a strategy toward improving kidney allocation to highly sensitized patients. Patients with a transplantability score ≤ 2% are potential candidates for the program. Samples are analyzed and acceptable antigens (HLA-A, B, C, DRB1, DRB3/4/5, DQB1, DQA1, DPB1, DPA1) are defined by the local tissue typing laboratory and finally evaluated by a steering committee. In the matching algorithm, patients have the highest priority when the donor's antigens are all among the recipient's own or acceptable HLA antigens. In the period from 2009 to 2020, we have transplanted 278 highly sensitized kidney patients through the program. The graft survival of the STAMP patients was compared with 9002 deceased donor kidney-transplanted patients, transplanted in the same time period. The 10-year graft survival was 73.4% (95% CI: 60.3-90.0) for STAMP and 82.9% (95% CI: 81.6-84.3) for the reference group. (p = .2). In conclusion, the 10-year allograft survival demonstrates that the STAMP allocation algorithm is immunological safe. The program is continuously monitored and evaluated, and the introduction of matching for all HLA loci is a huge improvement to the program and demonstrate technical adaptability as well as clinical flexibility in a de-centralized organization.
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Affiliation(s)
| | - Mats Bengtsson
- Department of Clinical Immunology, Rudbeck Laboratory, Uppsala University Hospital, Uppsala, Sweden
| | | | - Christian Naper
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway
| | - Kaie Lokk
- Tartu University Hospital, Tissue Typing Laboratory, Tartu, Estonia
| | - Ilkka Helanterä
- Helsinki University Hospital, Transplantation and Liver Surgery, Helsinki, Finland
| | | | | | - Lars Wennberg
- Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Varberg Reisaeter
- Department of Transplantation Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Bjarne Møller
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
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8
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Dello Strologo L, Spada M, Vici CD, Atti MCD, Rheault M, Bjerre AK, Boyer O, Calvo PL, D'Antiga L, Harshman LA, Hörster F, Kölker S, Jahnukainen T, Knops N, Krug P, Krupka K, Lee A, Levtchenko E, Marks SD, Stojanovic J, Martelli L, Mazariegos G, Montini G, Shenoy M, Sidhu S, Spada M, Tangeras T, Testa S, Vijay S, Wac K, Wennberg L, Concepcion W, Garbade SF, Tönshoff B. Renal outcome and plasma methylmalonic acid levels after isolated or combined liver or kidney transplantation in patients with methylmalonic acidemia: A multicenter analysis. Mol Genet Metab 2022; 137:265-272. [PMID: 36240580 DOI: 10.1016/j.ymgme.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Methylmalonic acidemia (MMAemia) is characterized by accumulation of methylmalonic acid (MMA) in all body tissues. To minimize disease-related complications, isolated kidney (KTx), liver (LTx) or combined liver-kidney transplantation (LKTx) have been suggested. However, the impact of these different transplant strategies on outcome are unclear. METHODS In this multicenter retrospective observational study, we compared plasma MMA levels and estimated glomerular filtration rate (eGFR) data of 83 patients. Sixty-eight patients (82%) had a mut0-type MMAemia, one patient had a mut--type MMAemia, and seven (7.3%) had an inherited defect in cobalamin metabolism (cblA- or cblB-type MMAemia). Median observation period was 3.7 years (0-15.1 years). RESULTS Twenty-six (31%) patients underwent KTx, 24 (29%) LTx and 33 (40%) LKTx. Posttransplant, mean plasma MMA concentration significantly decreased in all three cohorts; but at month 12, plasma MMA in KTx (1372 ± 1101 μmol/L) was 7.8-fold higher than in LTx (176 ± 103 μmol/L; P < 0.001) and 6.4-fold higher than in LKTx (215 ± 110 μmol/L; P < 0.001). Comparable data were observed at month 24. At time of transplantation, mean eGFR in KTx was 18.1 ± 24.3 mL/min/1.73 m2, in LTx 99.8 ± 29.9 mL/min/1.73 m2, and in LKTx 31.5 ± 21.2 mL/min/1.73 m2. At month 12 posttransplant, mean eGFR in KTx (62.3 ± 30.3 mL/min/1.73 m2) was 33.4% lower than in LTx (93.5 ± 18.3 mL/min/1.73 m2; P = 0.0053) and 25.4% lower than in LKTx (83.5 ± 26.9 mL/min/1.73 m2; P = 0.0403). CONCLUSIONS In patients with isolated MMAemia, LTx and LKTx lead to markedly lower plasma MMA levels during the first 2 years posttransplant than KTx and are associated with a better preservation of kidney function. LTx should therefore be part of the transplant strategy in MMAemia.
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Affiliation(s)
| | - Marco Spada
- Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | | | | | - Anna Kristina Bjerre
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Olivia Boyer
- Hopital Necker - Enfant Malades, MARHEA, Institut Imagine, Université Paris Cité, Paris, France
| | | | - Lorenzo D'Antiga
- Paediatric Hepatology, Gastroenterology and Transplantation Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Friederike Hörster
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Stefan Kölker
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Timo Jahnukainen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital Helsinki, Finland
| | - Noël Knops
- Department of Pediatric Nephrology & Growth and Regeneration, University Hospitals Leuven & University of Leuven, Belgium
| | - Pauline Krug
- Hopital Necker - Enfant Malades, MARHEA, Institut Imagine, Université Paris Cité, Paris, France
| | - Kai Krupka
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Angela Lee
- Division of Transplantation, Stanford University School of Medicine, USA
| | - Elena Levtchenko
- Department of Pediatric Nephrology & Growth and Regeneration, University Hospitals Leuven & University of Leuven, Belgium
| | - Stephen D Marks
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Jelena Stojanovic
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Laura Martelli
- Paediatric Hepatology, Gastroenterology and Transplantation Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - George Mazariegos
- Pediatric Transplant Surgery, UPMC Children's Hospital of Pittsburgh, USA
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplantation Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milan, Italy
| | - Mohan Shenoy
- Pediatric Nephrology, Royal Manchester Children's Hospital, UK
| | - Sangeet Sidhu
- Pediatric Nephrology, Royal Manchester Children's Hospital, UK
| | - Marco Spada
- Department of Pediatrics, University of Torino, Turin, Italy
| | - Trine Tangeras
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway
| | - Sara Testa
- Pediatric Nephrology, Dialysis and Transplantation Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milan, Italy
| | - Suresh Vijay
- Pediatrics, Birmingham Children's Hospital NHS Foundation Trust, UK
| | - Katarzyna Wac
- Division of Transplantation, Stanford University School of Medicine, USA
| | - Lars Wennberg
- Department of Transplantation Surgery, Karolinska University Hospital Stockholm, Sweden
| | - Waldo Concepcion
- Division of Transplantation, Stanford University School of Medicine, USA
| | - Sven F Garbade
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany.
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9
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Levin A, Schwarz A, Hulkko J, He L, Sun Y, Barany P, Bruchfeld A, Herthelius M, Wennberg L, Ebefors K, Patrakka J, Betsholtz C, Nyström J, Mölne J, Hultenby K, Witasp A, Wernerson A. The role of dendrin in IgA nephropathy. Nephrol Dial Transplant 2022; 38:311-321. [PMID: 35767852 PMCID: PMC9923709 DOI: 10.1093/ndt/gfac208] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Immunoglobulin A nephropathy (IgAN) and its systemic variant IgA vasculitis (IgAV) damage the glomeruli, resulting in proteinuria, hematuria and kidney impairment. Dendrin is a podocyte-specific protein suggested to be involved in the pathogenesis of IgAN. Upon cell injury, dendrin translocates from the slit diaphragm to the nucleus, where it is suggested to induce apoptosis and cytoskeletal changes, resulting in proteinuria and accelerated disease progression in mice. Here we investigated gene and protein expression of dendrin in relation to clinical and histopathological findings to further elucidate its role in IgAN/IgAV. METHODS Glomerular gene expression was measured using microarray on 30 IgAN/IgAV patients, 5 patients with membranous nephropathy (MN) and 20 deceased kidney donors. Dendrin was spatially evaluated on kidney tissue sections by immunofluorescence (IF) staining (IgAN patients, n = 4; nephrectomized kidneys, n = 3) and semi-quantified by immunogold electron microscopy (IgAN/IgAV patients, n = 21; MN, n = 5; living kidney donors, n = 6). Histopathological grading was performed according to the Oxford and Banff classifications. Clinical data were collected at the time of biopsy and follow-up. RESULTS Dendrin mRNA levels were higher (P = .01) in IgAN patients compared with MN patients and controls and most prominently in patients with preserved kidney function and fewer chronic histopathological changes. Whereas IF staining did not differ between groups, immunoelectron microscopy revealed that a higher relative nuclear dendrin concentration in IgAN patients was associated with a slower annual progression rate and milder histopathological changes. CONCLUSION Dendrin messenger RNA levels and relative nuclear protein concentrations are increased and associated with a more benign phenotype and progression in IgAN/IgAV patients.
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Affiliation(s)
| | - Angelina Schwarz
- Department of Clinical Science, Intervention and Technology, Divison of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Liqun He
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Ying Sun
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Peter Barany
- Department of Clinical Science, Intervention and Technology, Divison of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annette Bruchfeld
- Department of Clinical Science, Intervention and Technology, Divison of Renal Medicine, Karolinska Institutet, Stockholm, Sweden,Department of Health, Medicine and Caring Sciences, Linköpings Universitet Hälsouniversitetet, Linkoping, Sweden
| | - Maria Herthelius
- Department of Clinical Science, Intervention, and Technology, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Wennberg
- Department of Clinical Science, Intervention and Technology, Division of Transplantation Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Ebefors
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jaakko Patrakka
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christer Betsholtz
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Jenny Nyström
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Mölne
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kjell Hultenby
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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10
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Erlandsson H, Qureshi AR, Ripsweden J, Haugen Löfman I, Söderberg M, Wennberg L, Lundgren T, Bruchfeld A, Brismar TB, Stenvinkel P. Scoring of medial arterial calcification predicts cardiovascular events and mortality after kidney transplantation. J Intern Med 2022; 291:813-823. [PMID: 35112417 PMCID: PMC9306575 DOI: 10.1111/joim.13459] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Progression of vascular calcification causes cardiovascular disease, which is the most common cause of death in chronic kidney failure and after kidney transplantation (KT). The prognostic impact of the extent of medial vascular calcification at KT is unknown. METHODS In this prospective cohort study, we investigated the impact of medial calcification compared to a mix of intimal and medial calcification represented by coronary artery calcification (CAC score) and aortic valve calcification in 342 patients starting on kidney failure replacement therapy. The primary outcomes were cardiovascular events (CVE) and death. The median follow-up time was 6.4 years (interquartile range 3.7-9.6 years). Exposure was CAC score and arteria epigastrica medial calcification scored as none, mild, moderate, or severe by a pathologist at time of KT (n = 200). We divided the patients according to kidney failure replacement therapy during follow-up, that is, living donor KT, deceased donor KT, or dialysis. RESULTS Moderate to severe medial calcification in the arteria epigastrica was associated with higher mortality (p = 0.001), and the hazard ratio for CVE was 3.1 (95% confidence interval [CI] 1.12-9.02, p < 0.05) compared to no or mild medial calcification. The hazard ratio for 10-year mortality in the dialysis group was 33.6 (95% CI, 10.0-113.0, p < 0.001) compared to living donor recipients, independent of Framingham risk score and prevalent CAC. CONCLUSION Scoring of medial calcification in the arteria epigastrica identified living donor recipients as having 3.1 times higher risk of CVE, independent of traditional risk factors. The medial calcification score could be a reliable method to identify patients with high and low risk of CVE and mortality following KT.
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Affiliation(s)
- Helen Erlandsson
- Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Abdul Rashid Qureshi
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Jonaz Ripsweden
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.,Unit of radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ida Haugen Löfman
- Section of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Söderberg
- Cardiovascular, Renal and Metabolism Safety, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gothenburg, Sweden
| | - Lars Wennberg
- Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Lundgren
- Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Torkel B Brismar
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.,Unit of radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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11
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Levin A, Schwarz A, Herthelius M, Wennberg L, Peter Barany F, Bruchfeld A, Witasp A, Wernerson A. FC047: RNA Sequencing of Microdissected Kidney Biopsies from IGA Nephropathy Patients. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac105.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
As the most common glomerulonephritis globally, mainly affecting younger adults and one of the most common causes of kidney failure [1], IgA Nephropathy (IgAN) poses an immense impact both on the individual and on the societal level. Here, we aimed to gain further molecular insight into the high interindividual variability of the clinical picture and disease progression by linking transcriptional profiling of IgAN-kidneys to clinical and histopathological data.
METHOD
Kidney biopsies from patients with histopathologically verified IgAN/IgA vasculitis (n = 84) (IgAV) [57 males, median (range) age of 39 (4–89) years] and 11 living donors (LD) [six males, median (range) age of 37 (30–65) years] were manually microdissected into glomerular and tubulointerstitial fractions. RNA was extracted with RNeasy lipid tissue mini kit (Qiagen, Valencia, CA, US) and evaluated using the Bioanalyzer 2100 (Agilent, Santa Clara, CA, US). mRNA purification, conversion to cDNA, fragmentation and double-stranded cDNA synthesis, amplification and clean-up were performed using Illumina Stranded mRNA prep ligation protocol (Illumina Inc). Paired-end RNA sequencing was performed in three different batches (Illumina Novaseq 6000).
Data pre-processing was done using Trim Galore (v.0.6.4). Reads were aligned to the Ensembl GRCh38 reference genome using STAR (v2.6.1d). Gene counts were obtained using featureCounts (v1.5.1). Quality control was made using MultiQC (v.1.7). Comparisons between groups were performed using Bioconductor package DESeq2 (v1.22.2) and gene set enrichment analysis using Bioconductor package fgsea.
The biopsies were evaluated by experienced renal pathologists using the Oxford classification [2] and the Banff classifications [3]. Clinical data at time of biopsy and 5-year follow-up was retrieved from patients’ files. Co-morbidity- and mortality data was extracted from the Swedish renal registry up to 19 years after the biopsy.
RESULTS
Principal Component Analysis showed clear separation between diseased and LD kidney transcriptomes, as well as between glomerular and tubulointerstitial fractions. Top upregulated genes in glomeruli were associated with complement activation and fibrosis. In tubulointerstium, top genes were related to the immune system, including chemokines. Gene ontology enrichment analysis highlighted immune response and complement activation in both compartments. Additionally, cell membrane and mitochondrial activity were enriched in tubulointerstium. Linking bioinformatic results to clinical data at the time of biopsy, progress over time as well as to histopathological data in accordance with the Oxford classification system [2] is ongoing.
CONCLUSION
This is, to our knowledge, the most comprehensive RNA sequencing performed on paired glomerular and tubulointerstitial tissue from patients with IgAN/IgAV. Initial bioinformatical analyses highlights biologically relevant processes involving different parts of the immune system. Our project has the potential to identify molecular processes associated with rapid disease progression and specific histopathological characteristics. This enables identification of patients with a more aggressive disease and individualized treatment depending on molecular profile, which would improve kidney survival and quality of life for patients suffering from IgAN/IgAV.
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Affiliation(s)
- Anna Levin
- Division of Renal Medicine, Karolinska Institutet, Clinical Science, Intervention and Technology, Stockholm, Sweden
| | - Angelina Schwarz
- Division of Renal Medicine, Karolinska Institutet, Clinical Science, Intervention and Technology, Stockholm, Sweden
| | - Maria Herthelius
- Paediatric Nephrology, Karolinska Institutet, The Children's and Women's Health Theme, Stockholm, Sweden
| | - Lars Wennberg
- Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Franz Peter Barany
- Division of Renal Medicine, Karolinska Institutet, Clinical Science, Intervention and Technology, Stockholm, Sweden
| | - Annette Bruchfeld
- Division of Renal Medicine, Karolinska Institutet, Clinical Science, Intervention and Technology, Stockholm, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Witasp
- Division of Renal Medicine, Karolinska Institutet, Clinical Science, Intervention and Technology, Stockholm, Sweden
| | - Annika Wernerson
- Division of Renal Medicine, Karolinska Institutet, Clinical Science, Intervention and Technology, Stockholm, Sweden
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12
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Budde K, Rostaing L, Maggiore U, Piotti G, Surace D, Geraci S, Procaccianti C, Nicolini G, Witzke O, Kamar N, Albano L, Büchler M, Pascual J, Gutiérrez-Dalmau A, Kuypers D, Wekerle T, Głyda M, Carmellini M, Tisone G, Midtvedt K, Wennberg L, Grinyó JM. Prolonged-Release Once-Daily Formulation of Tacrolimus Versus Standard-of-Care Tacrolimus in de novo Kidney Transplant Patients Across Europe. Transpl Int 2022; 35:10225. [PMID: 36017158 PMCID: PMC9397503 DOI: 10.3389/ti.2021.10225] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/27/2021] [Indexed: 11/24/2022]
Abstract
Background: Tacrolimus is the calcineurin inhibitor of choice for preventing acute rejection episodes in kidney transplant patients. However, tacrolimus has a narrow therapeutic range that requires regular monitoring of blood concentrations to minimize toxicity. A new once-daily tacrolimus formulation, LCP-tacrolimus (LCPT), has been developed, which uses MeltDose™ drug-delivery technology to control drug release and enhance overall bioavailability. Our study compared dosing of LCPT with current standard-of-care tacrolimus [immediate-release tacrolimus (IR-Tac) or prolonged-release tacrolimus (PR-Tac)] during the 6 months following de novo kidney transplantation. Comparisons of graft function, clinical outcomes, safety, and tolerability for LCPT versus IR-Tac/PR-Tac were also performed. Methods: Standard immunological risk patients with end-stage renal disease who had received a de novo kidney transplant were randomized (1:1) to LCPT (N = 200) or IR-Tac/PR-Tac (N = 201). Results: Least squares (LS) mean tacrolimus total daily dose from Week 3 to Month 6 was significantly lower for LCPT than for IR-Tac/PR-Tac. Although LS mean tacrolimus trough levels were significantly higher for LCPT than IR-Tac/PR-Tac, tacrolimus trough levels remained within the standard reference range for most patients. There were no differences between the groups in treatment failure measures or safety profile. Conclusion: LCPT can achieve similar clinical outcomes to other tacrolimus formulations, with a lower daily dose. Clinical Trial Registration:https://clinicaltrials.gov/, identifier NCT02432833.
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Affiliation(s)
- Klemens Budde
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
- *Correspondence: Klemens Budde,
| | - Lionel Rostaing
- Service de Néphrologie, Dialyse, Aphérèses et Transplantation, CHU Grenoble Alpes, Grenoble, France
| | - Umberto Maggiore
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | | | | | | | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, Universitätsmedizin Essen, University of Duisburg-Essen, Essen, Germany
| | - Nassim Kamar
- Departments of Nephrology and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR–BMT, Université Paul Sabatier, Toulouse, France
| | - Laetitia Albano
- Unité de Transplantation Rénale, Hôpital Pasteur 2, CHU Nice, Nice, France
| | - Matthias Büchler
- Service de Néphrologie et Transplantation Rénale, CHRU de Tours, Tours, France
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Alex Gutiérrez-Dalmau
- Department of Nephrology, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
| | - Dirk Kuypers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Wekerle
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Maciej Głyda
- Department of Transplantology, Surgery and Urology, District Hospital, Poznan, Poland, and Nicolaus Copernicus University Collegium Medicum, Bydgoszcz, Poland
| | - Mario Carmellini
- Department of Surgery and Bioengineering, University of Siena, Siena, Italy
| | | | - Karsten Midtvedt
- Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lars Wennberg
- Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Josep M. Grinyó
- Department of Nephrology, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
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13
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Hernandez L, Ward LJ, Arefin S, Ebert T, Laucyte-Cibulskiene A, Heimbürger O, Barany P, Wennberg L, Stenvinkel P, Kublickiene K. Blood-brain barrier and gut barrier dysfunction in chronic kidney disease with a focus on circulating biomarkers and tight junction proteins. Sci Rep 2022; 12:4414. [PMID: 35292710 PMCID: PMC8924178 DOI: 10.1038/s41598-022-08387-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 10/28/2021] [Accepted: 02/28/2022] [Indexed: 11/09/2022] Open
Abstract
Kidney failure and associated uraemia have implications for the cardiovascular system, brain, and blood–brain barrier (BBB). We aim to examine BBB disruption, by assessing brain-derived neurotropic factor (BDNF), neuron-specific enolase (NSE) levels, and gut-blood barrier (GBB) disruption by trimethylamine N-oxide (TMAO), in chronic kidney disease (CKD) patients. Additionally, endothelial tight-junction protein expressions and modulation via TMAO were assessed. Serum from chronic kidney disease (CKD) female and male haemodialysis (HD) patients, and controls, were used to measure BDNF and NSE by enzyme-linked immunosorbent assays, and TMAO by mass spectrometry. Immunofluorescent staining of subcutaneous fat biopsies from kidney transplant recipients, and controls, were used to measure microvascular expression of tight-junction proteins (claudin-5, occludin, JAM-1), and control microvasculature for TMAO effects. HD patients versus controls, had significantly lower and higher serum levels of BDNF and NSE, respectively. In CKD biopsies versus controls, reduced expression of claudin-5, occludin, and JAM-1 were observed. Incubation with TMAO significantly decreased expression of all tight-junction proteins in the microvasculature. Uraemia affects BBB and GBB resulting in altered levels of circulating NSE, BDNF and TMAO, respectively, and it also reduces expression of tight-junction proteins that confer BBB maintenance. TMAO serves as a potential candidate to alter BBB integrity in CKD.
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Affiliation(s)
- Leah Hernandez
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Karolinska Institutet, 14186, Stockholm, Sweden
| | - Liam J Ward
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Karolinska Institutet, 14186, Stockholm, Sweden
| | - Samsul Arefin
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Karolinska Institutet, 14186, Stockholm, Sweden
| | - Thomas Ebert
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Karolinska Institutet, 14186, Stockholm, Sweden
| | - Agne Laucyte-Cibulskiene
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Karolinska Institutet, 14186, Stockholm, Sweden.,Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden
| | | | - Olof Heimbürger
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Karolinska Institutet, 14186, Stockholm, Sweden
| | - Peter Barany
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Karolinska Institutet, 14186, Stockholm, Sweden
| | - Lars Wennberg
- Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Stenvinkel
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Karolinska Institutet, 14186, Stockholm, Sweden
| | - Karolina Kublickiene
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Karolinska Institutet, 14186, Stockholm, Sweden.
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14
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Witasp A, Luttropp K, Qureshi AR, Barany P, Heimbürger O, Wennberg L, Ekström TJ, Shiels PG, Stenvinkel P, Nordfors L. Longitudinal genome-wide DNA methylation changes in response to kidney failure replacement therapy. Sci Rep 2022; 12:470. [PMID: 35013499 PMCID: PMC8748627 DOI: 10.1038/s41598-021-04321-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/08/2021] [Accepted: 12/13/2021] [Indexed: 01/01/2023] Open
Abstract
Chronic kidney disease (CKD) is an emerging public health priority associated with high mortality rates and demanding treatment regimens, including life-style changes, medications or even dialysis or renal transplantation. Unavoidably, the uremic milieu disturbs homeostatic processes such as DNA methylation and other vital gene regulatory mechanisms. Here, we aimed to investigate how dialysis or kidney transplantation modifies the epigenome-wide methylation signature over 12 months of treatment. We used the Infinium HumanMethylation450 BeadChip on whole blood samples from CKD-patients undergoing either dialysis (n = 11) or kidney transplantation (n = 12) and 24 age- and sex-matched population-based controls. At baseline, comparison between patients and controls identified several significant (PFDR < 0.01) CpG methylation differences in genes with functions relevant to inflammation, cellular ageing and vascular calcification. Following 12 months, the global DNA methylation pattern of patients approached that seen in the control group. Notably, 413 CpG sites remained differentially methylated at follow-up in both treatment groups compared to controls. Together, these data indicate that the uremic milieu drives genome-wide methylation changes that are partially reversed with kidney failure replacement therapy. Differentially methylated CpG sites unaffected by treatment may be of particular interest as they could highlight candidate genes for kidney disease per se.
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Affiliation(s)
- Anna Witasp
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, M99, 141 86, Stockholm, Sweden
| | - Karin Luttropp
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Abdul Rashid Qureshi
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, M99, 141 86, Stockholm, Sweden
| | - Peter Barany
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, M99, 141 86, Stockholm, Sweden
| | - Olof Heimbürger
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, M99, 141 86, Stockholm, Sweden
| | - Lars Wennberg
- Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas J Ekström
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Paul G Shiels
- College of Medical, Veterinary and Life Sciences Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, M99, 141 86, Stockholm, Sweden
| | - Louise Nordfors
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, M99, 141 86, Stockholm, Sweden.
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15
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Steinmetz-Späh J, Arefin S, Larsson K, Jahan J, Mudrovcic N, Wennberg L, Stenvinkel P, Korotkova M, Kublickiene K, Jakobsson PJ. Effects of microsomal prostaglandin E synthase-1 (mPGES-1) inhibition on resistance artery tone in patients with end stage kidney disease. Br J Pharmacol 2021; 179:1433-1449. [PMID: 34766335 DOI: 10.1111/bph.15729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Inhibition of the microsomal prostaglandin (PG) E2 synthase (mPGES-1) introduces a promising anti-inflammatory treatment approach by specifically reducing PGE2 . The microvasculature is a central target organ for early manifestations of cardiovascular disease. Therefore, a better understanding of the prostaglandin system and characterising the effects of mPGES-1 inhibition in this vascular bed are of interest. EXPERIMENTAL APPROACH The effects of mPGES-1 inhibition on constriction and relaxation of resistance arteries (Ø100-400μm) from patients with end stage kidney disease (ESKD) and controls (Non-ESKD) were studied using wire-myography in combination with immunological and mass-spectrometry based analyses. KEY RESULTS Inhibition of mPGES-1 in arteries from ESKD patients and Non-ESKD controls significantly reduced adrenergic vasoconstriction, which was not affected by the COX-2 inhibitors NS-398 and Etoricoxib or the COX-1/COX-2 inhibitor Indomethacin, tested in Non-ESKD controls. Correspondingly, a significant increase of acetylcholine-induced dilatation was observed for mPGES-1 inhibition only. In IL-1β treated arteries, inhibition of mPGES-1 significantly reduced PGE2 levels while PGI2 levels remained unchanged. In contrast, COX-2 inhibition blocked the formation of both prostaglandins. Blockage of PGI2 signaling with an IP receptor antagonist did not restore the reduced constriction, neither did blocking of PGE2 -EP4 or signaling through PPARγ. A biphasic effect was observed for PGE2 , inducing dilatation at nmol and constriction at μmol concentrations. Immunohistochemistry demonstrated expression of mPGES-1, COX-1, PGIS, weak expression for COX-2 as well as receptor expression for PGE2 (EP1-4), thromboxane (TP) and PGI2 (IP) in ESKD and Non-ESKD. CONCLUSION Our study demonstrates vasodilating effects following mPGES-1 inhibition in human microvasculature and suggests that several pathways besides shunting to PGI2 may be involved.
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Affiliation(s)
- Julia Steinmetz-Späh
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden
| | - Samsul Arefin
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, Stockholm, Sweden
| | - Karin Larsson
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden
| | - Jabin Jahan
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden
| | - Neja Mudrovcic
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, Stockholm, Sweden
| | - Lars Wennberg
- Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, Stockholm, Sweden
| | - Marina Korotkova
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, Stockholm, Sweden
| | - Per-Johan Jakobsson
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden
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16
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Erlandsson H, Qureshi AR, Scholz T, Lundgren T, Bruchfeld A, Stenvinkel P, Wennberg L, Lindnér P. Observational study of risk factors associated with clinical outcome among elderly kidney transplant recipients in Sweden - a decade of follow-up. Transpl Int 2021; 34:2363-2370. [PMID: 34346109 DOI: 10.1111/tri.14004] [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: 02/08/2021] [Revised: 07/05/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Kidney transplantation (Ktx) in elderly has become increasingly accepted worldwide despite their higher burden of comorbidities. We investigated important risk factors affecting long-term patient and graft survival. METHODS We included all (n=747) Ktx patients >60 years from 2000 to 2012 in Sweden. Patients were age-stratified; 60-64, 65-69 and >70 years. Follow-up time was up to 10 years (median 7.9 years, 75% percentile >10 years). Primary outcome was 10-year patient survival in age-stratified groups. Secondary outcomes were 5- year patient and graft-survival in age-stratified groups and the impact of risk factors including Charlson comorbidity index on patient and graft-survival. RESULTS Mortality was higher in patients >70 years, after 10 years (HR 1.94; 95% CI 1.24-3.04; p=0.004). Males had a higher 10-year risk of death (HR 1.39; CI 95% 1.04-1.86; p=0.024). Five-year patient survival did not differ between age-groups. In multivariate Cox analysis (n=500) hazard ratio for 10-year mortality was 4.6 in patients with Charlson comorbidity index ≥7 vs <4 (95% CI 2.42-8.62; p=0.0001) CONCLUSION: Higher Charlson comorbidity index identified ESKD patients with 4.6 times higher risk of death after Ktx. We suggest that this index should be used as a part of the pre-operative evaluation in elderly.
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Affiliation(s)
- Helen Erlandsson
- Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Abdul Rashid Qureshi
- Department of Health, Medicine and Caring Sciences, Linköping University, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Tim Scholz
- Department of Transplantation, Uppsala University Hospital, Uppsala, Sweden
| | - Torbjörn Lundgren
- Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lars Wennberg
- Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Per Lindnér
- The Transplant Institute, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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17
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Baker A, Frauca Remacha E, Torres Canizales J, Bravo-Gallego LY, Fitzpatrick E, Alonso Melgar A, Muñoz Bartolo G, Garcia Guereta L, Ramos Boluda E, Mozo Y, Broniszczak D, Jarmużek W, Kalicinski P, Maecker-Kolhoff B, Carlens J, Baumann U, Roy C, Chardot C, Benetti E, Cananzi M, Calore E, Dello Strologo L, Candusso M, Lopes MF, Brito MJ, Gonçalves C, Do Carmo C, Stephenne X, Wennberg L, Stone R, Rascon J, Lindemans C, Turkiewicz D, Giraldi E, Nicastro E, D’Antiga L, Ackermann O, Jara Vega P. Current Practices on Diagnosis, Prevention and Treatment of Post-Transplant Lymphoproliferative Disorder in Pediatric Patients after Solid Organ Transplantation: Results of ERN TransplantChild Healthcare Working Group Survey. Children (Basel) 2021; 8:children8080661. [PMID: 34438552 PMCID: PMC8394841 DOI: 10.3390/children8080661] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/25/2022]
Abstract
(1) Background: Post-transplant lymphoproliferative disease (PTLD) is a significant complication of solid organ transplantation (SOT). However, there is lack of consensus in PTLD management. Our aim was to establish a present benchmark for comparison between international centers and between various organ transplant systems and modalities; (2) Methods: A cross-sectional questionnaire of relevant PTLD practices in pediatric transplantation was sent to multidisciplinary teams from 17 European center members of ERN TransplantChild to evaluate the centers’ approach strategies for diagnosis and treatment and how current practices impact a cross-sectional series of PTLD cases; (3) Results: A total of 34 SOT programs from 13 European centers participated. The decision to start preemptive treatment and its guidance was based on both EBV viremia monitoring plus additional laboratory methods and clinical assessment (61%). Among treatment modalities the most common initial practice at diagnosis was to reduce the immunosuppression (61%). A total of 126 PTLD cases were reported during the period 2012–2016. According to their histopathological classification, monomorphic lesions were the most frequent (46%). Graft rejection after PTLD remission was 33%. Of the total cases diagnosed with PTLD, 88% survived; (4) Conclusions: There is still no consensus on prevention and treatment of PTLD, which implies the need to generate evidence. This might successively allow the development of clinical guidelines.
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Affiliation(s)
- Alastair Baker
- Paediatric Liver, Gastrointestinal and Nutrition Centre, School of Medicine, King’s College Hospital, King’s College London, Denmark Hill, London SE5 9RS, UK; (A.B.); (E.F.)
| | - Esteban Frauca Remacha
- Servicio de Hepatología Pediátrica, Hospital Universitario La Paz, 28046 Madrid, Spain; (E.F.R.); (G.M.B.); (P.J.V.)
| | - Juan Torres Canizales
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute of Biomedical Research (IdiPAZ), Hospital Universitario La Paz and Center for Biomedical Network Research on Rare Diseases (CIBERER U767), 28046 Madrid, Spain;
| | - Luz Yadira Bravo-Gallego
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute of Biomedical Research (IdiPAZ), Hospital Universitario La Paz and Center for Biomedical Network Research on Rare Diseases (CIBERER U767), 28046 Madrid, Spain;
- Correspondence: ; Tel.: +34-917277576
| | - Emer Fitzpatrick
- Paediatric Liver, Gastrointestinal and Nutrition Centre, School of Medicine, King’s College Hospital, King’s College London, Denmark Hill, London SE5 9RS, UK; (A.B.); (E.F.)
| | - Angel Alonso Melgar
- Servicio de Nefrología Pediátrica, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Gema Muñoz Bartolo
- Servicio de Hepatología Pediátrica, Hospital Universitario La Paz, 28046 Madrid, Spain; (E.F.R.); (G.M.B.); (P.J.V.)
| | - Luis Garcia Guereta
- Servicio de Cardiología Pediátrica, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Esther Ramos Boluda
- Pediatric Gastroenterology Intestinal Rehabilitation Unit, University Hospital La Paz, 28046 Madrid, Spain;
| | - Yasmina Mozo
- Pediatric Hemato-Oncology Department, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Dorota Broniszczak
- Department of Pediatric Surgery and Organ Transplantation, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (D.B.); (P.K.)
| | - Wioletta Jarmużek
- Department of Nephrology and Kidney Transplantation, Children’s Memorial Health Institute, 04-730 Warsaw, Poland;
| | - Piotr Kalicinski
- Department of Pediatric Surgery and Organ Transplantation, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (D.B.); (P.K.)
| | - Britta Maecker-Kolhoff
- Department of Pediatric Hematology and Oncology, Hannover Medical School, 30625 Hannover, Germany;
| | - Julia Carlens
- Clinic for Paediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany;
| | - Ulrich Baumann
- Division of Paediatric Gastroenterology and Hepatology, Children’s Hospital, Hannover Medical School, 30625 Hannover, Germany;
| | - Charlotte Roy
- Service de Pneumologie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, Université Paris, 75015 Paris, France;
| | - Christophe Chardot
- Service de Chirurgie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, 75015 Paris, France;
| | - Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women’s and Children’s Health, Azienda Ospedaliera di Padova, 35128 Padova, Italy;
| | - Mara Cananzi
- Unit of Paediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, Department of Women’s and Children’s Health, Azienda Ospedaliera di Padova, 35128 Padova, Italy;
| | - Elisabetta Calore
- Unit of Paediatric Onco-Haematology, Department of Women’s and Children’s Health, Azienda Ospedaliera di Padova, 35128 Padova, Italy;
| | - Luca Dello Strologo
- Nephrology Unit, Bambino Gesù Children’s Research Hospital, IRCCS, 00165 Rome, Italy;
| | - Manila Candusso
- Department of Hepatology and Gastroenterology, Bambino Gesù Children Hospital, 00165 Rome, Italy;
| | - Maria Francelina Lopes
- Department of Paediatric Surgery, Centro Hospitalar e Universitário de Coimbra, and Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal;
| | - Manuel João Brito
- Department of Paediatric Oncology and Centro de Investigação e Formação Clínica, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
| | - Cristina Gonçalves
- Paediatric Liver Transplant Unit, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
| | - Carmen Do Carmo
- Paediatric Nephrology Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
| | - Xavier Stephenne
- Laboratoire d’Hépatologie Pédiatrique et Thérapie Cellulaire, Unité PEDI, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium;
| | - Lars Wennberg
- Department of Transplantation Surgery, Karolinska University Hospital, 171 76 Stockholm, Sweden;
| | - Rosário Stone
- Unidade de Nefrologia e Transplantação Renal, Serviço de Pediatria Médica, Departamento de Pediatria, Hospital de Santa Maria, Centro Académico de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal;
| | - Jelena Rascon
- Centre for Paediatric Oncology and Haematology, Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania;
| | - Caroline Lindemans
- Princess Maxima Center for Pediatric Oncology, Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht University, 3584 CS Utrecht, The Netherlands;
| | - Dominik Turkiewicz
- Department of Pediatrics, Skåne University Hospital, 222 42 Lund, Sweden;
| | - Eugenia Giraldi
- Pediatric Oncology, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Emanuele Nicastro
- Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (E.N.); (L.D.)
| | - Lorenzo D’Antiga
- Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (E.N.); (L.D.)
| | - Oanez Ackermann
- Pediatric Hepatology, National Centre for Biliary Atresia, Université París-Saclay, APHP, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France;
| | - Paloma Jara Vega
- Servicio de Hepatología Pediátrica, Hospital Universitario La Paz, 28046 Madrid, Spain; (E.F.R.); (G.M.B.); (P.J.V.)
- La Paz Institute of Biomedical Research, IdiPAZ, Hospital Universitario La Paz, 28046 Madrid, Spain
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18
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Neytchev O, Witasp A, Nordfors L, Qureshi ART, Wennberg L, Erlandsson H, Ebert T, Selman C, Shiels P, Stenvinkel P. FC 123RENAL TRANSPLANTATION MITIGATES INCREASED BIOLOGICAL (EPIGENETIC) AGE IN CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab147.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background and Aims
Chronic kidney disease (CKD) shares important features of a dysregulated ageing process with other common “burden of lifestyle” diseases, which aggregates into the diseasome of ageing. Typically, this is hallmarked by an acceleration of epigenetic (DNA methylation-based) clocks. It remains to be determined if current therapeutic interventions, such as renal transplantation or dialysis, can slow this clock, and thus the rate of biological ageing, in CKD. We therefore assessed the rate of biological ageing in CKD patients and whether these therapies impact on it, by measuring epigenetic age before and 1 year after treatment.
Methods
Whole blood samples were taken from CKD 5 patients at baseline and 1 year after renal transplantation (n=12) or dialysis (n=11; peritoneal dialysis n=7, haemodialysis n=4) as well as from age and sex-matched population-based controls (n=24). DNA methylation was measured using the Illumina Infinium Human Methylation 450K BeadChip and epigenetic age was calculated using three independent DNA methylation clocks: the Horvath, Hannum, and PhenoAge clocks. Additionally, a novel composite clock incorporating these three clocks was evaluated. We then calculated the age acceleration (difference between epigenetic and chronological age) for each clock and compared average age acceleration between groups and across time points.
Results
Incident dialysis patients displayed accelerated ageing versus chronologically age-matched controls (p<0.001). We observed a PhenoAge age acceleration difference in both the transplant (8.5 years, p=0.001) and dialysis (9.7 years, p<0.001) groups at baseline compared to control. After 1 year, we also observed a decrease of the age acceleration in the transplant group (mean reduced by 4.4 years, p=0.016), but not in the dialysis group (mean reduced by 0.7 years, p=0.668).
Conclusion
CKD 5 patients display an increased biological (i.e. epigenetic) age. This age acceleration is mitigated one year after renal transplantation, but not in patients undergoing dialysis. Neither therapy reverses high biological age.
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Affiliation(s)
- Ognian Neytchev
- University of Glasgow, United Kingdom, College of Medical, Veterinary & Life Sciences Institute of Cancer Sciences, Glasgow, United Kingdom
| | - Anna Witasp
- Karolinska Institutet, Renal Medicine M99, Stockholm, Sweden
| | - Louise Nordfors
- Karolinska Institutet, Renal Medicine M99, Stockholm, Sweden
| | | | - Lars Wennberg
- Karolinska Institutet, Transplantation, Stockholm, Sweden
| | | | - Thomas Ebert
- Karolinska Institutet, Renal Medicine M99, Stockholm, Sweden
| | - Colin Selman
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary & Life Sciences Institute of Cancer Sciences, Glasgow, United Kingdom
| | - Paul Shiels
- University of Glasgow, United Kingdom, College of Medical, Veterinary & Life Sciences Institute of Cancer Sciences, Glasgow, United Kingdom
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19
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Hernandez L, Ward L, Ebert T, Arefin S, Heimbürger O, Barany FP, Wennberg L, Stenvinkel P, Kublickiene K. MO445BRAIN AND GUT AXIS IN CHRONIC KIDNEY DISEASE: FOCUS ON SPECIFIC BIOMARKERS, AND TIGHT JUNCTION PROTEINS. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab090.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Chronic kidney disease (CKD) is a progressive systemic disease that affect the microvascular permeability of the blood-brain barrier (BBB) and intestinal barrier leading to increased morbidity, mortality and central nervous system symptoms. In this study we examined the relationship of blood brain and intestinal barrier dysfunction in relation to uraemic environment and increased risk of developing neurologic complications and mortality. In addition, potential proteins conferring the junctional communications were assessed.
Method
The study included serum samples from 216 prevalent haemodialysis (HD), 80 peritoneal dialysis (PD) and 80 healthy subjects. Permeability of the BBB was evaluated by measuring serum concentrations for brain-specific biomarkers S100B, NSE (neuron specific enolase), BDNF (brain-derived neurotrophic factor), GFAP (glial fibrillary acidic protein) using ELISA. TMAO (trimethylamine-N-Oxide) as a surrogate of gut generated uraemic toxins was analysed by mass spectrophotometry. Subcutaneous fat tissues with identified microvessels from 10 kidney transplant recipients and 11 donors were examined for expression of tight junction proteins claudin-5, occludin and JAM-1 (junction adhesion molecule-1) by immunohistochemical staining.
Results
HD and PD groups showed elevated cholesterol, triglyceride, creatinine, hsCRP and lower BMI, and P-albumin compared to healthy controls. BDNF serum concentrations were lower in both HD (14.0 ng/mL, IQR 8.7-19.2) and PD (17.9 ng/mL, IQR 14.4-23.4) vs controls (20.2 ng/mL, IQR 16.7-25.7). Similarly, S100B serum concentrations were lower in both HD (31.6 pg/mL, IQR 9.4-186) and PD (49.4 pg/mL, IQR 9.8-118) vs control (87.3 pg/mL, IQR 13.3-749). Conversely, NSE serum concentrations were higher in both HD (5.3 ng/mL, IQR 4.4-6.6) and PD (4.0 ng/mL, IQR 3.6-4.7) vs controls (3.5 ng/mL, IQR 2.9-4.3). Finally, TMAO serum concentration were also higher in both HD (6.4 ng/μL, IQR 4.0-11.2) and PD (3.8 ng/μL, IQR 2.2-6.3) vs controls (0.4 ng/μL, IQR 0.3-0.6). No significant sex differences in biomarker concentration were found, except for TMAO in healthy controls. Immunohistochemistry studies of endothelial tight junction proteins in microvessels, within the subcutaneous fat tissues, showed reduced expression of claudin-5 (5%), occludin (6%) and JAM-1 (5%) in kidney transplant patients vs donors (7%, 8% and 8%, respectively), and ongoing studies are indicating a trend for altered expression of tight junction proteins after ex vivo stimulation with TMAO.
Conclusion
We report that CKD5 patients showed disruption of BBB and intestinal barrier resulting in altered circulating serum levels of brain-specific biomarkers, secondary to a disruption in the tight junction protein markers in microvasculature of adipose tissue. These findings imply that it is important to continuously monitor cognitive function(s) in CKD. Further studies are needed to assess direct effect of TMAO on tight junction proteins which confer vascular permeability.
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Affiliation(s)
- Leah Hernandez
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Huddinge, Sweden
| | - Liam Ward
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Huddinge, Sweden
| | - Thomas Ebert
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Huddinge, Sweden
| | - Samsul Arefin
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Huddinge, Sweden
| | - Olof Heimbürger
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Huddinge, Sweden
| | - Franz Peter Barany
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Huddinge, Sweden
| | - Lars Wennberg
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Transplantation Surgery, Huddinge, Sweden
| | - Peter Stenvinkel
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Huddinge, Sweden
| | - Karolina Kublickiene
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Huddinge, Sweden
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20
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De Juan Pardo MA, Fuster P, Gallart A, Rodríguez E, Wennberg L, Martin-Ferreres ML. Fostering leadership competence and satisfaction in nursing undergraduates through a student-led conference: A quasi-experimental pre-post study. Nurse Educ Today 2021; 98:104748. [PMID: 33517182 DOI: 10.1016/j.nedt.2021.104748] [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] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/04/2020] [Accepted: 01/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Numerous benefits have been reported for student-led conferences, such as increased leadership. This competence has been recognized as important for nurses so as to ensure the provision of safe and high-quality care in complex environments. However, research has yet to examine empirically the impact of student-led conferences on students' leadership behaviours. OBJECTIVES To examine the impact that participation in a student-led conference had on the self-perceived leadership competence of nursing undergraduates. DESIGN Quasi-experimental single group pre-post intervention study. SETTING Faculty of Medicine and Health Sciences at the Universitat Internacional de Catalunya. PARTICIPANTS 31 students enrolled in two elective modules offered during the final year (fourth year) of a nursing degree programme. METHODS Pre-post assessment of self-perceived leadership behaviours among nursing students involved in planning and organizing a scientific conference. In addition to carrying out the tasks of organizing the Conference, all students participated as co-authors of an oral communication, thus being able to develop both cognitive and non-cognitive domains. Leadership was measured using ES_SALI scale, the Spanish version of the Self-Assessment Leadership Instrument. RESULTS Involvement in the student-led conference led to a statistically significant increase in self-perceived leadership competence among nursing undergraduates (p < .001). Both the total ES_SALI score and scores on each of its four dimensions (Strategic thinking, Emotional intelligence, Impact and influence, and Teamwork skills) increased significantly, and the percentage change was above 8% in all cases (p < .01). The greatest increase (10.99%) corresponded to the 'Impact and influence' dimension of leadership. CONCLUSIONS The results suggest that student-led conferences are an effective way of helping nursing undergraduates to develop their leadership competence.
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Affiliation(s)
- M A De Juan Pardo
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain.
| | - P Fuster
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - A Gallart
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - E Rodríguez
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - L Wennberg
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - M L Martin-Ferreres
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
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21
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Skov K, Weinreich ID, Bruunsgaard H, Bistrup C, Sørensen SS, Koefoed-Nielsen P, Wennberg L, Lindnér P, Andersson T. [The Nordic kidneyexchangeprogramme]. Ugeskr Laeger 2020; 182:V04200209. [PMID: 33118497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This review describes the ScandiaTransplant Kidney Exchange Programme and the background of renal exchange programmes gaining popularity worldwide, possibilities and limitations of the programmes, the ethical aspects and perspectives. The first kidney exchanges between Danish and Swedish countries were performed in 2019, and until now 23 exchanges and transplantations have been performed. All surgical procedures have been performed simultaneously and/or coordinated at different hospitals in Scandinavia, and the kidney grafts were transported between the participating units.
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22
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Doná D, Torres Canizales J, Benetti E, Cananzi M, De Corti F, Calore E, Hierro L, Ramos Boluda E, Melgosa Hijosa M, Garcia Guereta L, Pérez Martínez A, Barrios M, Costa Reis P, Teixeira A, Lopes MF, Kaliciński P, Branchereau S, Boyer O, Debray D, Sciveres M, Wennberg L, Fischler B, Barany P, Baker A, Baumann U, Schwerk N, Nicastro E, Candusso M, Toporski J, Sokal E, Stephenne X, Lindemans C, Miglinas M, Rascon J, Jara P. Pediatric transplantation in Europe during the COVID-19 pandemic: Early impact on activity and healthcare. Clin Transplant 2020; 34:e14063. [PMID: 32786120 PMCID: PMC7435500 DOI: 10.1111/ctr.14063] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022]
Abstract
The current pandemic SARS‐CoV‐2 has required an unusual allocation of resources that can negatively impact chronically ill patients and high‐complexity procedures. Across the European Reference Network on Pediatric Transplantation (ERN TransplantChild), we conducted a survey to investigate the impact of the COVID‐19 outbreak on pediatric transplant activity and healthcare practices in both solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT). The replies of 30 professionals from 18 centers in Europe were collected. Twelve of 18 centers (67%) showed a reduction in their usual transplant activity. Additionally, outpatient visits have been modified and restricted to selected ones, and the use of telemedicine tools has increased. Additionally, a total of 14 COVID‐19 pediatric transplanted patients were identified at the time of the survey, including eight transplant recipients and six candidates for transplantation. Only two moderate‐severe cases were reported, both in HSCT setting. These survey results demonstrate the limitations in healthcare resources for pediatric transplantation patients during early stages of this pandemic. COVID‐19 disease is a major worldwide challenge for the field of pediatric transplantation, where there will be a need for systematic data collection, encouraging regular discussions to address the long‐term consequences for pediatric transplantation candidates, recipients, and their families.
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Affiliation(s)
- Daniele Doná
- Pediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Juan Torres Canizales
- La Paz Institute of Biomedical Research - IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Mara Cananzi
- Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Federica De Corti
- Pediatric Surgery, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Elisabetta Calore
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Loreto Hierro
- La Paz Institute of Biomedical Research - IdiPAZ, La Paz University Hospital, Madrid, Spain.,Pediatric Hepatology Department, La Paz University Hospital, Madrid, Spain
| | - Esther Ramos Boluda
- Pediatric Gastroenterology Intestinal Rehabilitation Unit, La Paz University Hospital, Madrid, Spain
| | | | | | - Antonio Pérez Martínez
- La Paz Institute of Biomedical Research - IdiPAZ, La Paz University Hospital, Madrid, Spain.,Pediatric Hemato-Oncology Department, La Paz University Hospital, Madrid, Spain
| | - Maribel Barrios
- Pediatric Pneumology Department, La Paz University Hospital, Madrid, Spain
| | - Patricia Costa Reis
- Pediatric Nephrology and Kidney Transplantation Unit, Pediatrics Department, Faculdade de Medicina, Hospital de Santa Maria, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Teixeira
- Department of Pediatric Nephrology, Pediatric Service, Centro Materno Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal
| | - Maria Francelina Lopes
- Department of Pediatric Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Piotr Kaliciński
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland
| | - Sophie Branchereau
- Pediatric Surgery Department, Hospital du Kremlin Bicêtre, Le Kremlin Bicêtre, France
| | - Olivia Boyer
- Service of Pediatric Nephrology, Hôpital Necker-Enfants Malades, AP-HP, Université de Paris Descartes, Paris, France
| | - Dominque Debray
- Pediatric Hepatology Unit, Reference Center for Biliary Atresia and Genetic cholestasis, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Centre, Paris, France
| | - Marco Sciveres
- Pediatric Hepatology and Liver Transplantation, ISMETT UPMC Palermo, Palermo, Italy
| | - Lars Wennberg
- Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Fischler
- Department of Pediatric Hepatology, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Peter Barany
- Department of Pediatric Nephrology, Karolinska University Hospital, Stockholm, Sweden
| | - Alastair Baker
- Pediatric Liver, Gastrointestinal and Nutrition Centre, King's College London School of Medicine at King's College Hospital, London, UK
| | - Ulrich Baumann
- Division of Pediatric Gastroenterology and Hepatology, Hannover Medical School, Children's Hospital, Hannover, Germany
| | - Nicolaus Schwerk
- Clinic for Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Emanuele Nicastro
- Centre for Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Manila Candusso
- Department of Hepatology and Gastroenterology, Bambino Gesù Children Hospital, Rome, Italy
| | - Jacek Toporski
- Section of Pediatric Oncology/Hematology, Department of Pediatrics, Skåne University Hospital, Lund, Sweden
| | - Etienne Sokal
- Laboratoire d'Hépatologie Pédiatrique et Thérapie Cellulaire, Unité PEDI, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Xavier Stephenne
- Service de Gastroentérologie et Hépatologie Pédiatrique, Département de Pédiatrie, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Caroline Lindemans
- Pediatric Blood and Marrow Transplantation Program, Prinses Maxima Centrum, Utrecht, Netherlands
| | - Marius Miglinas
- Faculty of Medicine, Nephrology Center, Vilnius University, Vilnius, Lithuania
| | - Jelena Rascon
- Centre for Pediatric Oncology and Haematology, Children's Hospital, Vilnius University Hospital, Vilnius, Lithuania
| | - Paloma Jara
- La Paz Institute of Biomedical Research - IdiPAZ, La Paz University Hospital, Madrid, Spain.,Pediatric Hepatology Department, La Paz University Hospital, Madrid, Spain
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23
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Andersson T, Wennberg L, Lindnér P, Duus Weinreich I, Skov K, Bistrup C. [The first kidney exchanges between two Scandinavian countries have been performed]. Lakartidningen 2020; 117:20005. [PMID: 32542613] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article describes the Scandinavian expansion of the previously described kidney exchange program STEP, and the first two exchanges that were performed between two Scandinavian countries late in 2019. All surgical procedures were performed simultaneously and/or coordinated at different hospitals in Scandinavia and the kidney grafts were transported between the participating units. Four weeks after surgery, all recipients had a good and stable kidney function and all donors had recovered.
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Affiliation(s)
| | | | - Per Lindnér
- docent, verksamhetschef, Transplantations-centrum, Sahlgrenska universitetssjukhuset, Göteborg
| | | | - Karin Skov
- docent, överläkare, Århus universitetssjukhus, Danmark
| | - Claus Bistrup
- docent, överläkare, Odense universitetssjukhus, Danmark
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24
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Franco I, Helgadottir H, Moggio A, Larsson M, Vrtacnik P, Johansson A, Norgren N, Lundin P, Mas-Ponte D, Nordstrom J, Lundgren T, Stenvinkel P, Wennberg L, Supek F, Eriksson M. SO042WHOLE GENOME SEQUENCING OF HUMAN KIDNEY PROGENITORS IDENTIFIES A MUTATION-PRONE CELL TYPE IN THE PROXIMAL TUBULE. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa139.so042] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
The genome of every cell accumulates somatic mutations while aging. Somatic mutation data can be used to track a cell´s exposure to mutagens, thereby allowing the discovery of cell types that are more susceptible to mutate and become cancer and the underling mechanisms.
Method
To detect somatic mutations in healthy, human kidney, we set up a protocol for whole genome DNA sequencing of single non-cancer cells. The protocol requires in vitro clonal expansion prior to sequencing, a step that restricts the analysis to cells able to proliferate in vitro (progenitors), but allows a gene expression analysis in addition to genome sequencing. Cells were obtained from six living kidney donors undergoing surgery. In addition to the kidney cortex biopsy, multiple control tissues (skin, subcutaneous fata and visceral fat) were obtained from each donor, allowing a well-controlled comparison of mutation landscapes in different cell types. Donors´ age spanned from 30 to 69.
Results
Somatic mutation and gene expression data showed that we were able to culture two different populations of CD133/CD24 positive, tubular cells. One population showed a low amount of somatic mutations and a mutation profile similar to progenitors from other tissues (fat, skeletal muscle and blood), consistent with a lack of exposure to mutagens. Conversely, the other population showed high mutation burden and a unique mutation landscape, characterized by mutation enrichment in active chromatin, regulatory, and transcribed regions. Accumulation of potential, cancer-driver mutations was 6-fold faster in these compared to control cells. The mutation profile was similar to that of the most common kidney cancer subtypes (clear cell- and papillary cell-carcinoma) and indicated that these cells originated from the proximal tubule, in agreement with gene expression data.
Conclusion
Our somatic mutation data from single genomes support the existence of two different populations of proliferating tubule cells in healthy, human kidney. One is protected from mutagen exposure, similar to stem cells from other organs. The other population is derived from damaged proximal tubule cells and shows a high mutation rate between 30 and 70 years of age. Mutations are enriched in transcribed genes and regulatory regions, thus enhancing the chances of tumorigenic transformation and suggesting conditions that predispose to cancer in the kidney proximal tubule.
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Affiliation(s)
- Irene Franco
- Karolinska Institute, Biosciences and Nutrition, Huddinge, Sweden
| | | | - Aldo Moggio
- Karolinska Institute, ICMC, Huddinge, Sweden
| | | | - Peter Vrtacnik
- Karolinska Institute, Biosciences and Nutrition, Huddinge, Sweden
| | | | | | | | | | - Johan Nordstrom
- Karolinska University Hospital, Division of Transplantation Surgery, Huddinge, Sweden
| | - Torbjörn Lundgren
- Karolinska University Hospital, Division of Transplantation Surgery, Huddinge, Sweden
| | - Peter Stenvinkel
- Karolinska University Hospital, Division of Renal Medicine, Huddinge, Sweden
| | - Lars Wennberg
- Karolinska University Hospital, Division of Transplantation Surgery, Huddinge, Sweden
| | | | - Maria Eriksson
- Karolinska Institute, Biosciences and Nutrition, Huddinge, Sweden
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25
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Dai L, Debowska M, Lukaszuk T, Bobrowski L, Barany P, Söderberg M, Thiagarajan D, Frostegård J, Wennberg L, Lindholm B, Qureshi AR, Waniewski J, Stenvinkel P. Phenotypic features of vascular calcification in chronic kidney disease. J Intern Med 2020; 287:422-434. [PMID: 31823455 DOI: 10.1111/joim.13012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/30/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with chronic kidney disease stage 5 (CKD5) are predisposed to vascular calcification (VC), but the combined effect of factors associated with VC was sparsely investigated. We applied the relaxed linear separability (RLS) feature selection model to identify features that concomitantly associate with VC in CKD5 patients. METHODS Epigastric arteries collected during surgery from living donor kidney transplant recipients were examined to score the histological extent of medial VC. Sixty-two phenotypic features in 152 patients were entered into RLS model to differentiate between no-minimal VC (n = 93; score 0-1) and moderate-extensive VC (n = 59; score 2-3). The subset of features associated with VC was selected on the basis of cross-validation procedure. The strength of association of the selected features with VC was expressed by the absolute value of 'RLS factor'. RESULTS Among 62 features, a subset of 17 features provided optimal prediction of VC with 89% of patients correctly classified into their groups. The 17 features included traditional risk factors (diabetes, age, cholesterol, BMI and male sex) and markers of bone metabolism, endothelial function, metabolites, serum antibodies and mitochondrial-derived peptide. Positive RLS factors range from 1.26 to 4.05 indicating features associated with increased risk of VC, and negative RLS factors range from -0.95 to -1.83 indicating features associated with reduced risk of VC. CONCLUSION The RLS model identified 17 features including novel biomarkers and traditional risk factors that together concomitantly associated with medial VC. These results may inform further investigations of factors promoting VC in CKD5 patients.
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Affiliation(s)
- L Dai
- From the, Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - M Debowska
- Department for Mathematical Modeling of Physiological Processes, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - T Lukaszuk
- Faculty of Computer Science, Bialystok University of Technology, Bialystok, Poland
| | - L Bobrowski
- Department for Mathematical Modeling of Physiological Processes, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland.,Faculty of Computer Science, Bialystok University of Technology, Bialystok, Poland
| | - P Barany
- From the, Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - M Söderberg
- Pathology, Clinical Pharmacology and Safety Sciences, AstraZeneca R&D, Gothenburg, Sweden
| | - D Thiagarajan
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - J Frostegård
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - L Wennberg
- Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - B Lindholm
- From the, Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - A R Qureshi
- From the, Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - J Waniewski
- Department for Mathematical Modeling of Physiological Processes, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - P Stenvinkel
- From the, Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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26
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Bratt O, Drevin L, Prütz KG, Carlsson S, Wennberg L, Stattin P. Prostate cancer in kidney transplant recipients - a nationwide register study. BJU Int 2020; 125:679-685. [DOI: 10.1111/bju.15002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ola Bratt
- Department of Urology; Institute of Clinical Science; Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
- Department of Urology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Linda Drevin
- Regional Cancer Centre, Uppsala-Örebro; Uppsala Sweden
| | | | - Stefan Carlsson
- Section of Urology; Department of Molecular Medicine and Surgery; Karolinska Institute; Stockholm Sweden
| | - Lars Wennberg
- Department of Transplantation Surgery; Karolinska University Hospital; Stockholm Sweden
| | - Pär Stattin
- Department of Surgical Sciences; Uppsala University; Uppsala Sweden
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27
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Franco I, Helgadottir HT, Moggio A, Larsson M, Vrtačnik P, Johansson A, Norgren N, Lundin P, Mas-Ponte D, Nordström J, Lundgren T, Stenvinkel P, Wennberg L, Supek F, Eriksson M. Whole genome DNA sequencing provides an atlas of somatic mutagenesis in healthy human cells and identifies a tumor-prone cell type. Genome Biol 2019; 20:285. [PMID: 31849330 PMCID: PMC6918713 DOI: 10.1186/s13059-019-1892-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/18/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The lifelong accumulation of somatic mutations underlies age-related phenotypes and cancer. Mutagenic forces are thought to shape the genome of aging cells in a tissue-specific way. Whole genome analyses of somatic mutation patterns, based on both types and genomic distribution of variants, can shed light on specific processes active in different human tissues and their effect on the transition to cancer. RESULTS To analyze somatic mutation patterns, we compile a comprehensive genetic atlas of somatic mutations in healthy human cells. High-confidence variants are obtained from newly generated and publicly available whole genome DNA sequencing data from single non-cancer cells, clonally expanded in vitro. To enable a well-controlled comparison of different cell types, we obtain single genome data (92% mean coverage) from multi-organ biopsies from the same donors. These data show multiple cell types that are protected from mutagens and display a stereotyped mutation profile, despite their origin from different tissues. Conversely, the same tissue harbors cells with distinct mutation profiles associated to different differentiation states. Analyses of mutation rate in the coding and non-coding portions of the genome identify a cell type bearing a unique mutation pattern characterized by mutation enrichment in active chromatin, regulatory, and transcribed regions. CONCLUSIONS Our analysis of normal cells from healthy donors identifies a somatic mutation landscape that enhances the risk of tumor transformation in a specific cell population from the kidney proximal tubule. This unique pattern is characterized by high rate of mutation accumulation during adult life and specific targeting of expressed genes and regulatory regions.
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Affiliation(s)
- Irene Franco
- Department of Biosciences and Nutrition, Center for Innovative Medicine, Karolinska Institutet, Huddinge, Sweden.
| | - Hafdis T Helgadottir
- Department of Biosciences and Nutrition, Center for Innovative Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Aldo Moggio
- Department of Medicine Huddinge, Integrated Cardio Metabolic Center, Karolinska Institutet, Huddinge, Sweden
| | - Malin Larsson
- Science for Life Laboratory, Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - Peter Vrtačnik
- Department of Biosciences and Nutrition, Center for Innovative Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Anna Johansson
- Science for Life Laboratory, Department of Cell and Molecular Biology, Uppsala University, Uppsala, Sweden
| | - Nina Norgren
- Science for Life Laboratory, Department of Molecular Biology, Umeå University, Umeå, Sweden
| | - Pär Lundin
- Department of Biosciences and Nutrition, Center for Innovative Medicine, Karolinska Institutet, Huddinge, Sweden
- Science for Life Laboratory, Department of Biochemistry and Biophysics (DBB), Stockholm University, Stockholm, Sweden
| | - David Mas-Ponte
- Genome Data Science, Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, 08028, Barcelona, Spain
| | - Johan Nordström
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Division of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden
| | - Torbjörn Lundgren
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Division of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden
| | - Peter Stenvinkel
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Division of Renal Medicine, Karolinska University Hospital, Huddinge, Sweden
| | - Lars Wennberg
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Division of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden
| | - Fran Supek
- Genome Data Science, Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, 08028, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Maria Eriksson
- Department of Biosciences and Nutrition, Center for Innovative Medicine, Karolinska Institutet, Huddinge, Sweden.
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28
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Wennberg L, Lindnér P, Linders J, Bengtsson M, Sedigh A, Andersson T. [First donations and transplantations performed in Swedish kidney exchange program]. Lakartidningen 2019; 116:FL4A. [PMID: 31192380] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article describes the Swedish kidney exchange program (STEP) and the first donations and transplantations that were performed in October 2018. A total of six parallel surgical procedures resulted in three kidney donations and three kidney transplantations. Two months after the operations, all recipients had good and stable kidney function and all donors had recovered. We argue that four specific problems must be addressed in order for the program to reach its full potential. These modifications are related to the information structure, a Scandinavian expansion, the role of ABO-incompatible transplants, and more sophisticated matching techniques.
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Affiliation(s)
- Lars Wennberg
- Karolinska Universitetsjukhuset i Huddinge - Patientområde Transplantation Huddinge, Sweden Karolinska institutet Department of Clinical Sciences Intervention and Technology - Department of Transplantation Surgery Huddinge, Sweden
| | - Per Lindnér
- Sahlgrenska universitetssjukhuset - Transplantationscentrum Goteborg, Sweden Sahlgrenska universitetssjukhuset - Transplantationscentrum Goteborg, Sweden
| | - Johan Linders
- Skanes universitetssjukhus Malmo - Transplantationsenheten Malmo, Sweden Skanes universitetssjukhus Malmo - Transplantationsenheten Malmo, Sweden
| | - Mars Bengtsson
- Akademiska sjukhuset - Klinisk immunologi och transfusionsmedicin Uppsala, Sweden Akademiska sjukhuset - Klinisk immunologi och transfusionsmedicin Uppsala, Sweden
| | - Amir Sedigh
- Akademiska sjukhuset - Transplantationsenheten Uppsala, Sweden Akademiska sjukhuset - Transplantationsenheten Uppsala, Sweden
| | - Tommy Andersson
- Lund University - Department of Economics Lund, Sweden Lund University - Department of Economics Lund, Sweden
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29
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Wadström J, von Zur-Mühlen B, Lennerling A, Westman K, Wennberg L, Fehrman Ekholm I. Living Anonymous Renal Donors Do Not Regret: Intermediate and Long-Term Follow-Up with a Focus on Motives and Psychosocial Outcomes. Ann Transplant 2019; 24:234-241. [PMID: 31023996 PMCID: PMC6507493 DOI: 10.12659/aot.913827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/10/2023] Open
Abstract
BACKGROUND Living anonymous donation (LAD) of kidneys was introduced in Sweden in 2004. This study reports on outcomes of Swedish LAD experiences from 2004 to 2016, focusing on donors' motives, the care they received, psychosocial aspects, and medical status at follow-up. MATERIAL AND METHODS Donor data were collected through a physician interview, medical check-up, review of medical charts, the Hospital Anxiety Depression Scale (HADS), and a routine national questionnaire. Of the 26 LADs during the study period, 1 donor died and 1 declined to participate, leaving a study population of 24. RESULTS Half of the donors were male, which is a higher proportion than for directed living donors. The major motive detected was altruism. Of the 24 LADs, 96% were very satisfied and would donate again if possible, 46% noted increased self-esteem, and a third were happier after the donation. Sixty-two percent received anonymous information about the recipient and 40% would have liked to meet the recipient. HADS scores were normal. Two donors had antidepressant treatment, 1 of whom had received treatment before donation. Half mentioned that the pre-donation assessment took too long. At follow-up, mean eGFR was 62±12 mL/min/1.73 m², of which 16 were in CKD II and 8 were in CKD III. Four donors had developed hypertension, 1 of whom also developed type 2 diabetes. CONCLUSIONS Swedish LADs are very satisfied and medical outcomes are acceptable. We propose that the transplant community and the National Board of Health and Welfare take a more active approach to informing the general public about LAD.
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Affiliation(s)
- Jonas Wadström
- Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden.,Department of Surgery/Transplantation, Hamad Medical Corporation, Doha, Qatar
| | | | - Annette Lennerling
- Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Westman
- Department of Nephrology and Transplantation, Skåne University Hospital, Malmö, Sweden
| | - Lars Wennberg
- Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden
| | - Ingela Fehrman Ekholm
- Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden
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30
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Dalianis T, Eriksson BM, Felldin M, Friman V, Hammarin AL, Herthelius M, Ljungman P, Mölne J, Wennberg L, Swartling L. Management of BK-virus infection - Swedish recommendations. Infect Dis (Lond) 2019; 51:479-484. [PMID: 31012777 DOI: 10.1080/23744235.2019.1595130] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BK-virus (BKV) associated nephropathy (BKVAN) and BKV associated haemorrhagic cystitis (HC) are complications of BKV infection/reactivation in renal and allogeneic haematopoietic stem cell transplantation (HSCT) patients, respectively. The task of how to manage these diseases was given to the chair by the Swedish Reference Group for Antiviral Therapy (RAV). After individual contributions by members of the working group, consensus discussions were held in a meeting on 23 January 2018 arranged by RAV. Thereafter, the recommendations were published in Swedish on November 2018. The current translation to English has been approved by all co-authors. High BKV serum levels suggest an increased risk for BKVAN and potential graft failure. For detection of BKVAN, careful monitoring of BKV DNA levels in serum or plasma is recommended the first year after renal transplantation and when increased creatinine serum levels of unknown cause are observed. Notably, a renal biopsy is mandatory for diagnosis. To reduce the risk for progression of BKVAN, there is no specific treatment, and tailored individual decrease of immunosuppression is recommended. For BKV-HC, BKV monitoring is not recommended, since BK-viruria frequently occurs in HSCT patients and the predictive value of BKV in plasma/serum has not been determined. However, the risk for BKV-HC is higher for patients undergoing myeloablative conditioning, having an unrelated, HLA-mismatched, or a cord blood donor, and awareness of the increased risk and early intervention may benefit the patients. Also for BKV-HC, no specific therapy is available. Symptomatic treatment, e.g. forced diuresis and analgesics could be of use.
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Affiliation(s)
- Tina Dalianis
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden
| | - Britt-Marie Eriksson
- b Department of Medical Science, Section of Infectious Diseases , Uppsala University , Uppsala , Sweden
| | - Marie Felldin
- c Transplant Institute, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Vanda Friman
- d Department of Infectious Diseases , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Anna-Lena Hammarin
- e Unit for Laboratory Development and Technology Transfer , The Public Health Agency of Sweden , Stockholm , Sweden
| | - Maria Herthelius
- f Paediatric Nephrology , The Children's and Women's Health Theme, Karolinska University Hospital , Stockholm , Sweden
| | - Per Ljungman
- g Department of Cellular Therapy and Allogeneic Stem Cell Transplantation , Karolinska University Hospital , Stockholm , Sweden
| | - Johan Mölne
- h Department of Pathology and Genetics , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Lars Wennberg
- i Department of Clinical Science, Intervention and Technology , Karolinska Institutet , Stockholm , Sweden.,j Department of Transplantation Surgery , Karolinska University Hospital , Stockholm , Sweden
| | - Lisa Swartling
- k Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
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31
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Fellström B, Holmdahl J, Sundvall N, Cockburn E, Kilany S, Wennberg L. Adherence of Renal Transplant Recipients to Once-daily, Prolonged-Release and Twice-daily, Immediate-release Tacrolimus-based Regimens in a Real-life Setting in Sweden. Transplant Proc 2018; 50:3275-3282. [DOI: 10.1016/j.transproceed.2018.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/27/2018] [Indexed: 02/05/2023]
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32
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Chen Z, Sun J, Haarhaus M, Barany P, Wennberg L, Ripsweden J, Brismar TB, Lindholm B, Wernerson A, Söderberg M, Stenvinkel P, Qureshi AR. Bone mineral density of extremities is associated with coronary calcification and biopsy-verified vascular calcification in living-donor renal transplant recipients. J Bone Miner Metab 2017; 35:536-543. [PMID: 27913900 DOI: 10.1007/s00774-016-0788-1] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 09/12/2016] [Indexed: 12/21/2022]
Abstract
Chronic kidney disease (CKD) mineral and bone disorders (CKD-MBD) may lead to low bone mineral density (BMD) and vascular calcification (VC), but links to the latter are unclear. Here we investigated associations between BMD, coronary artery calcium (CAC) scores, and histological signs of VC in end-stage renal disease (ESRD) patients undergoing living-donor kidney transplantation (LD-Rtx). In 66 ESRD patients (median age 45 years, 68% males), BMD (by dual-energy X-ray absorptiometry, DXA), CAC score (by computed tomography, CT; n = 54), and degree of VC score (graded by histological examination of epigastric artery specimens collected at LD-Rtx; n = 55) were assessed at the time of LD-Rtx. Of the patients, 26% had osteopenia and 7% had osteoporosis. Of those undergoing artery biopsy, 16% had extensive VC, and of those undergoing CT 28% had high CAC score (>100 Agatston units). CAC scores correlated with BMD of legs and pelvis. BMDs of leg and pelvic sub-regions were significantly lower in patients with extensive VC. In multivariate regression analysis adjusted for age and gender, lower BMD of leg sub-region was associated with CAC score >100 AUs and extensive VC, and patients with extensive VC had significantly higher CAC score. Both high CAC and extensive VC were independently predicted by low BMD of legs. Low BMD has the potential to identify ESRD patients at risk of vascular calcification.
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Affiliation(s)
- Zhimin Chen
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, M-99 Karolinska University Hospital, Huddinge, CLINTEC, SE-141 86, Stockholm, Sweden
- Kidney Disease Center, 1st Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou, China
| | - Jia Sun
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, M-99 Karolinska University Hospital, Huddinge, CLINTEC, SE-141 86, Stockholm, Sweden
| | - Mathias Haarhaus
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, M-99 Karolinska University Hospital, Huddinge, CLINTEC, SE-141 86, Stockholm, Sweden
| | - Peter Barany
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, M-99 Karolinska University Hospital, Huddinge, CLINTEC, SE-141 86, Stockholm, Sweden
| | - Lars Wennberg
- Transplantation Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Jonaz Ripsweden
- Radiology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | | | - Bengt Lindholm
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, M-99 Karolinska University Hospital, Huddinge, CLINTEC, SE-141 86, Stockholm, Sweden
| | - Annika Wernerson
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, M-99 Karolinska University Hospital, Huddinge, CLINTEC, SE-141 86, Stockholm, Sweden
| | - Magnus Söderberg
- Pathology, Drug Safety and Metabolism, AstraZeneca, Mölndal, Sweden
| | - Peter Stenvinkel
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, M-99 Karolinska University Hospital, Huddinge, CLINTEC, SE-141 86, Stockholm, Sweden
| | - Abdul Rashid Qureshi
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, M-99 Karolinska University Hospital, Huddinge, CLINTEC, SE-141 86, Stockholm, Sweden.
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Jordan SC, Lorant T, Choi J, Kjellman C, Winstedt L, Bengtsson M, Zhang X, Eich T, Toyoda M, Eriksson BM, Ge S, Peng A, Järnum S, Wood KJ, Lundgren T, Wennberg L, Bäckman L, Larsson E, Villicana R, Kahwaji J, Louie S, Kang A, Haas M, Nast C, Vo A, Tufveson G. IgG Endopeptidase in Highly Sensitized Patients Undergoing Transplantation. N Engl J Med 2017; 377:442-453. [PMID: 28767349 DOI: 10.1056/nejmoa1612567] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Donor-specific antibodies create an immunologic barrier to transplantation. Current therapies to modify donor-specific antibodies are limited and ineffective in the most highly HLA-sensitized patients. The IgG-degrading enzyme derived from Streptococcus pyogenes (IdeS), an endopeptidase, cleaves human IgG into F(ab')2 and Fc fragments inhibiting complement-dependent cytotoxicity and antibody-dependent cellular cytotoxicity, which suggests that IdeS might be useful for desensitization. We report on the combined experience of two independently performed open-label, phase 1-2 trials (conducted in Sweden and the United States) that assessed the efficacy of IdeS with regard to desensitization and transplantation of a kidney from an HLA-incompatible donor. METHODS We administered IdeS to 25 highly HLA-sensitized patients (11 patients in Uppsala or Stockholm, Sweden, and 14 in Los Angeles) before the transplantation of a kidney from an HLA-incompatible donor. Frequent monitoring for adverse events, outcomes, donor-specific antibodies, and renal function was performed, as were renal biopsies. Immunosuppression after transplantation consisted of tacrolimus, mycophenolate mofetil, and glucocorticoids. Patients in the U.S. study also received intravenous immune globulin and rituximab after transplantation to prevent antibody rebound. RESULTS Recipients in the U.S. study had a significantly longer cold ischemia time (the time elapsed between procurement of the organ and transplantation), a significantly higher rate of delayed graft function, and significantly higher levels of class I donor-specific antibodies than those in the Swedish study. A total of 38 serious adverse events occurred in 15 patients (5 events were adjudicated as being possibly related to IdeS). At transplantation, total IgG and HLA antibodies were eliminated. A total of 24 of 25 patients had perfusion of allografts after transplantation. Antibody-mediated rejection occurred in 10 patients (7 patients in the U.S. study and 3 in the Swedish study) at 2 weeks to 5 months after transplantation; all these patients had a response to treatment. One graft loss, mediated by non-HLA IgM and IgA antibodies, occurred. CONCLUSIONS IdeS reduced or eliminated donor-specific antibodies and permitted HLA-incompatible transplantation in 24 of 25 patients. (Funded by Hansa Medical; ClinicalTrials.gov numbers, NCT02224820 , NCT02426684 , and NCT02475551 .).
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Affiliation(s)
- Stanley C Jordan
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Tomas Lorant
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Jua Choi
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Christian Kjellman
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Lena Winstedt
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Mats Bengtsson
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Xiaohai Zhang
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Torsten Eich
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Mieko Toyoda
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Britt-Marie Eriksson
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Shili Ge
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Alice Peng
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Sofia Järnum
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Kathryn J Wood
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Torbjorn Lundgren
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Lars Wennberg
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Lars Bäckman
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Erik Larsson
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Rafael Villicana
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Joe Kahwaji
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Sabrina Louie
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Alexis Kang
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Mark Haas
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Cynthia Nast
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Ashley Vo
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
| | - Gunnar Tufveson
- From the Comprehensive Transplant Center (S.C.J., J.C., M.T., S.G., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunotherapy Program (S.C.J., J.C., A.P., R.V., J.K., S.L., A.K., A.V.), Transplant Immunology Laboratory (S.C.J., M.T., S.G.), HLA Laboratory (X.Z.), and the Department of Pathology (M.H., C.N.), Cedars-Sinai Medical Center, Los Angeles; the Section of Transplantation Surgery, Department of Surgical Sciences (T. Lorant, L.B., G.T.), the Section of Molecular and Morphological Pathology (M.B., E.L.) and the Section of Clinical Immunology (T.E.), Department of Immunology, Genetics, and Pathology, and the Section of Infectious Diseases, Department of Medical Sciences (B.-M.E.), Uppsala University, Uppsala, Hansa Medical, Lund (C.K., L. Winstedt, S.J.), and the Division of Transplantation Surgery, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, and the Department of Transplantation Surgery, Karolinska University Hospital, Stockholm (T. Lundgren, L. Wennberg) - all in Sweden; and the Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom (K.J.W.)
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Tibell A, Rafael E, Wennberg L, Nordenström J, Bergström M, Geller RL, Loudovaris T, Johnson RC, Brauker JH, Neuenfeldt S, Wernerson A. Survival of Macroencapsulated Allogeneic Parathyroid Tissue One Year after Transplantation in Nonimmunosuppressed Humans. Cell Transplant 2017. [DOI: 10.3727/000000001783986404] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Annika Tibell
- Departments of Transplantation Surgery, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden
| | - Ehab Rafael
- Departments of Transplantation Surgery, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden
| | - Lars Wennberg
- Departments of Transplantation Surgery, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden
| | - Jörgen Nordenström
- Departments of Surgery, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden
| | - Mats Bergström
- Departments of Clinical Chemistry, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden
| | | | | | | | | | | | - Annika Wernerson
- Departments of Transplantation Surgery, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden
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Wennberg L, Sundberg B, Ekdahl-Nilsson K, Korsgren O. C-Peptide Determinations in Islet Xenotransplantation: A Study in the Pig-to-Mouse Model. Cell Transplant 2017. [DOI: 10.3727/000000001783986918] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- L. Wennberg
- Department of Transplantation Surgery, Karolinska Institute, Huddinge Hospital, Huddinge, Sweden
| | - B. Sundberg
- Department of Transplantation Surgery, Karolinska Institute, Huddinge Hospital, Huddinge, Sweden
| | - K. Ekdahl-Nilsson
- Department of Clinical Immunology, Uppsala University, Uppsala, Sweden
| | - O. Korsgren
- Department of Clinical Immunology, Uppsala University, Uppsala, Sweden
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Witasp A, Nordfors L, Olausen H, Wernerson A, Söderberg M, Wennberg L, Thorell A, Qureshi AR, Shiels P, Stenvinkel P. MO025ARTERIAL GENE EXPRESSION SIGNATURES FOR SIRTUINS AND KLOTHO ASSOCIATE WITH BIOPSY VERIFIED ARTERIAL CALCIFICATION IN END-STAGE RENAL DISEASE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx117.mo025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Koefoed-Nielsen P, Weinreich I, Bengtsson M, Lauronen J, Naper C, Gäbel M, Sørensen SS, Wennberg L, Reisaeter AV, Møller BK. Scandiatransplant acceptable mismatch program (STAMP) a bridge to transplanting highly immunized patients. HLA 2017; 90:17-24. [PMID: 28449350 DOI: 10.1111/tan.13046] [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: 01/05/2017] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Highly immunized patients are a challenge for organ transplantation programs. One way of increasing the likelihood of transplantation in this group of patients is to expand the possible donations by defining acceptable HLA mismatches. In the Scandiatransplant Acceptable Mismatch Program (STAMP), a de-centralized approach has been implemented in 2009. AIMS The program has been improved during the years from utilizing HLA-A, -B, -DR matching only to include typing of all deceased donors for HLA-A, -B, -C, -DRB1 and -DQB1. The calculation of a transplantability score (TS) has been introduced in order to take both HLA and AB0 into consideration resulting in a more realistic picture of the transplantability chance. MATERIALS AND METHODS Patients were selected for eligibility and results of immunisation status were prepared in each of the 9 tissue typing laboratories, while access to the program is finally governed by a common steering group of immunologists and clinicians. RESULTS In the period from March 2009 until February 2015, 96 patients were transplanted within this program. The mean recipient age was 49 years and 57% were females, 30% of the patients were first transplants and of these 93% were females. The majority of the patients had 2-5 HLA-A, -B. -DR mismatches. The allograft survival at 60 months was 79.1%. Applying the TS to the cohort confirmed that patients with a low TS score had longer waiting times. CONCLUSION The program has matured during the years and now proves to be a valid approach for transplanting highly immunized patients.
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Affiliation(s)
- P Koefoed-Nielsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | | | - M Bengtsson
- Department of Clinical Immunology, Rudbeck Laboratory, Uppsala University Hospital, Uppsala, Sweden
| | - J Lauronen
- Finnish Red Cross Blood Service, Helsinki, Finland
| | - C Naper
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway
| | - M Gäbel
- Sahlgrenska University Hospital, Institute of Transplantation, Gothenburg, Sweden
| | - S S Sørensen
- Department of Nephrology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - L Wennberg
- Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - A V Reisaeter
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - B K Møller
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
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Stenvinkel P, Luttropp K, McGuinness D, Witasp A, Rashid Qureshi A, Wernerson A, Nordfors L, Schalling M, Ripsweden J, Wennberg L, Söderberg M, Bárány P, Olauson H, Shiels PG. CDKN2A/p16INK4a expression is associated with vascular progeria in chronic kidney disease. Aging (Albany NY) 2017; 9:494-507. [PMID: 28192277 PMCID: PMC5361677 DOI: 10.18632/aging.101173] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 02/03/2017] [Indexed: 04/08/2023]
Abstract
Patients with chronic kidney disease (CKD) display a progeric vascular phenotype linked to apoptosis, cellular senescence and osteogenic transformation. This has proven intractable to modelling appropriately in model organisms. We have therefore investigated this directly in man, using for the first time validated cellular biomarkers of ageing (CDKN2A/p16INK4a, SA-β-Gal) in arterial biopsies from 61 CKD patients undergoing living donor renal transplantation. We demonstrate that in the uremic milieu, increased arterial expression of CDKN2A/p16INK4a associated with vascular progeria in CKD, independently of chronological age. The arterial expression of CDKN2A/p16INK4a was significantly higher in patients with coronary calcification (p=0.01) and associated cardiovascular disease (CVD) (p=0.004). The correlation between CDKN2A/p16INK4a and media calcification was statistically significant (p=0.0003) after correction for chronological age. We further employed correlate expression of matrix Gla protein (MGP) and runt-related transcription factor 2 (RUNX2) as additional pathognomonic markers. Higher expression of CDKN2A/p16INK4a, RUNX2 and MGP were observed in arteries with severe media calcification. The number of p16INK4a and SA-β-Gal positive cells was higher in biopsies with severe media calcification. A strong inverse correlation was observed between CDKN2A/p16INK4a expression and carboxylated osteocalcin levels. Thus, impaired vitamin K mediated carboxylation may contribute to premature vascular senescence.
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Affiliation(s)
- Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Luttropp
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dagmara McGuinness
- Wolfson Wohl Translational Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Anna Witasp
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Abdul Rashid Qureshi
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Annika Wernerson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Louise Nordfors
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Martin Schalling
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jonaz Ripsweden
- Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Stockholm, Sweden
| | - Lars Wennberg
- Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Söderberg
- Pathology, Drug Safety and Metabolism, AstraZeneca, Mölndal, Sweden
| | - Peter Bárány
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Hannes Olauson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Paul G Shiels
- Wolfson Wohl Translational Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
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Sönnerborg IV, Höglund P, Nordström J, Wikman A, Wennberg L, Nowak G. Severe Transplantation-Mediated Alloimmune Thrombocytopenia in 2 Recipients of Organs From the Same Donor. Transplantation 2017; 101:e190-e192. [PMID: 28145996 DOI: 10.1097/tp.0000000000001669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Isabella V Sönnerborg
- 1 Department of Transplant Surgery, Karolinska University Hospital, Stockholm, Sweden. 2 Division of Clinical Science Intervention and Technology, Karolinska Institute, Stockholm, Sweden. 3 Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden. 4 Division of Medicine, Karolinska Institute, Stockholm, Sweden. 5 Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
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Chen Z, Qureshi AR, Ripsweden J, Wennberg L, Heimburger O, Lindholm B, Barany P, Haarhaus M, Brismar TB, Stenvinkel P. Vertebral bone density associates with coronary artery calcification and is an independent predictor of poor outcome in end-stage renal disease patients. Bone 2016; 92:50-57. [PMID: 27519971 DOI: 10.1016/j.bone.2016.08.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/06/2016] [Accepted: 08/08/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Chronic kidney disease-mineral bone disorder (CKD-MBD) is a major complication of end-stage renal disease (ESRD). Reduced bone mineral density (BMD) is associated with vascular calcification. Here we investigated associations between vertebral bone density (VBD) and coronary artery calcification (CAC), quantified by cardiac computed tomography (CT), and BMD quantified by dual-energy X-ray absorptiometry (DXA), and their relations with mortality. METHODS In 231 ESRD patients (median age 56years, 63% males) comprising incident dialysis patients, prevalent peritoneal dialysis patients and recipients of living donor kidney transplant, VBD (Hounsfield units, HUs) and CAC scores (Agatston units, AUs) were quantified by cardiac CT, and, in 143 of the patients, BMD was measured by DXA of total body. Metabolic and inflammation biomarkers potentially linked to CKD-MBD were also analysed. RESULTS Patients with low tertile of VBD were older and had more often cardiovascular disease (CVD), and higher HbA1c (non-diabetics), interleukin-6 and CAC score. Low VBD was independently associated with higher CAC score (>100 AUs) after adjustment for age, gender, diabetes, CVD, inflammation and cohorts. In Cox proportional hazards analysis, low VBD was independently associated with all-cause mortality after adjustment for age, gender, diabetes, CVD, inflammation and subjective global assessment (SGA). The root mean-squared error of prediction (RMSE) showed a good degree of association between VBD and BMD evaluated from DXA. In receiver-operator characteristics curve (ROC) analysis, lower VBD was more strongly associated with higher CAC score and all-cause mortality than BMD evaluated from DXA. CONCLUSIONS While assessments of BMD by DXA and CT showed good degree of agreement, associations of high CAC, and mortality, with low VBD were stronger than those based on low BMD by DXA. The strong independent associations of low VBD with high CAC score and increased mortality risk suggest that VBD may serve as an important prognosticator in ESRD patients.
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Affiliation(s)
- Zhimin Chen
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Kidney Disease Center, 1st Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou, China
| | - Abdul Rashid Qureshi
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Jonaz Ripsweden
- Division of Medical Imaging and Technology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Huddinge, Sweden
| | - Lars Wennberg
- Division of Transplantation Surgery, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Olof Heimburger
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Barany
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mathias Haarhaus
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Torkel B Brismar
- Division of Medical Imaging and Technology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Huddinge, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
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Jahnukainen T, Bjerre A, Larsson M, Tainio J, Thiesson HC, Jalanko H, Schwartz Sørensen S, Wennberg L. The second report of the Nordic Pediatric Renal Transplantation Registry 1997-2012: More infant recipients and improved graft survivals. Pediatr Transplant 2016; 20:364-71. [PMID: 26857893 DOI: 10.1111/petr.12686] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2016] [Indexed: 11/29/2022]
Abstract
The NPRTSG has collected data on pediatric KTx since 1994. The registry archives information from all centers that perform pediatric KTx in Denmark, Finland, Norway, and Sweden and has 100% coverage. The first NPRTSG report was published in 1998 and was based on data collected in the 1982─1996 period. The present report provides data on 602 pediatric KTx in the Nordic countries from 1997 to 2012. Comparison of the patient demographics and one- and three-yr graft survivals between the two time cohorts revealed no significant change in the recipient and donor demographics. The number of transplantations increased by approximately 30%, doubling the recipients below the age of two yr. The use of Tac and mycophenolate as primary immunosuppression increased from practically 0% to 50% and 40%, respectively. The one- and three-yr graft survivals improved significantly (p < 0.001), especially among the youngest recipients with transplant from DD. In these patients, the one-yr survival improved from 70% to 94.6% and the three-yr graft survival from 60% to 94.6%, respectively. The improved graft survival may be at least partly due to changes in immunosuppression strategies, but also greater experience may also be of importance.
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Affiliation(s)
- Timo Jahnukainen
- Department of Pediatric Nephrology and Transplantation, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anna Bjerre
- Division of Specialised Medicine, Department of Pediatrics, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Marie Larsson
- Department of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Juuso Tainio
- Department of Pediatric Nephrology and Transplantation, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Helle C Thiesson
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Hannu Jalanko
- Department of Pediatric Nephrology and Transplantation, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Søren Schwartz Sørensen
- Department of Nephrology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Wennberg
- Department of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Chen Z, Haarhaus M, Olauson H, Barany P, Wennberg L, Ripsweden J, Brismar T, Bergström I, Lindholm B, Stenvinkel P, Stenvinkel P, Qureshi AR. MP738BONE MINERAL DENSITY IN LIVING DONOR RENAL TRANSPLANTATION RECIPENTS ASSOCIATES WITH FIBROBLAST GROWTH FACTOR23. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw200.62] [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: 11/14/2022] Open
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Cooper DKC, Buhler L, Breimer M, Korsgren O, Tibell A, Wennberg L, Cozzi E, d'Apice AJF, Hering B, McKenzie IFC, Pierson RN, Sykes M, Kobayashi T. Tribute to Carl-Gustav Groth (1933-2014), first president of the International Xenotransplantation Association. Xenotransplantation 2014; 21:97-8. [PMID: 25268247 DOI: 10.1111/xen.12098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Taube D, Jones G, O'Beirne J, Wennberg L, Connor A, Rasmussen A, Backman L. Generic tacrolimus in solid organ transplantation. Clin Transplant 2014; 28:623-32. [PMID: 24750309 DOI: 10.1111/ctr.12336] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2014] [Indexed: 11/28/2022]
Affiliation(s)
- D. Taube
- Imperial College Academic Health Science Centre; London UK
| | - G. Jones
- UCL Centre for Nephrology; Royal Free Hospital; London UK
| | - J. O'Beirne
- Shelia Sherlock Liver Centre; UCL Institute of Liver and Digestive Health; Royal Free Hospital; London UK
| | - L. Wennberg
- Department of Transplantation Surgery; Karolinska University Hospital; Stockholm Sweden
| | - A. Connor
- South West Transplant Centre; Derriford Hospital; Plymouth UK
| | - A. Rasmussen
- Department of General Surgery and Transplantation; Rigshospitalet; Copenhagen Denmark
| | - L. Backman
- Transplantation Surgery; Uppsala University Hospital; Uppsala Sweden
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Rosenborg S, Nordström A, Almquist T, Wennberg L, Bárány P. Systematic conversion to generic tacrolimus in stable kidney transplant recipients. Clin Kidney J 2014; 7:151-155. [PMID: 24944783 PMCID: PMC3970341 DOI: 10.1093/ckj/sfu015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 09/14/2013] [Accepted: 02/13/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Tacrolimus (Prograf®) is a key drug in the immunosuppressive treatment of renal transplant patients. Since the expiration of the patent for Prograf®, generic preparations have been approved in Europe as bioequivalence has been shown in healthy volunteers. However, few studies have investigated whether patients can be successfully converted from Prograf® to generic tacrolimus. Tacrolimus drug costs are by far the largest single item in the total drug expenditure for patients with renal disease in the Stockholm area. Considerable reductions in drug costs could be achieved if generic tacrolimus were to be used. The aim of this quality assurance study was to evaluate whether a switch from Prograf® to generic tacrolimus (Tacrolimus Sandoz®) could be safely performed in renal transplant patients. It further aimed to investigate changes of renal function (measured in estimated glomerular filtration rate, eGFR), need for dose changes and to calculate potential drug cost savings as a result of the conversion. METHODS We planned to recruit at least 50 patients. Plasma creatinine levels and trough concentrations of tacrolimus were collected from patients with renal transplants at three occasions during treatment with Prograf® and three times after conversion to Tacrolimus Sandoz®. The eGFR was calculated before and after the conversion. RESULTS Sixty-three of 67 enrolled patients (69% males, age 28-80 years) are included in this analysis. The ratio of mean trough concentrations of tacrolimus after comparison with before conversion was 1.02 (90% confidence interval 0.95-1.09). Fourteen patients experienced a change in tacrolimus levels >20% compared with baseline, no patients changed >20% in eGFR. The drug cost saving per daily dose was 33.40 SEK (∼€3.60, -23%). CONCLUSIONS Stable kidney transplant patients treated with Prograf® can be converted to Tacrolimus Sandoz® if trough concentrations of tacrolimus and plasma creatinine levels are closely monitored. The conversion brought savings, despite costs for extra monitoring.
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Affiliation(s)
- Staffan Rosenborg
- Department of Clinical Pharmacology , Karolinska University Hospital , Stockholm , Sweden ; Department of Renal Medicine , Karolinska University Hospital , Stockholm , Sweden
| | - Annica Nordström
- Department of Clinical Pharmacology , Karolinska University Hospital , Stockholm , Sweden
| | - Tora Almquist
- Department of Transplantation Surgery , Karolinska University Hospital , Stockholm , Sweden
| | - Lars Wennberg
- Department of Renal Medicine , Danderyd University Hospital , Stockholm , Sweden
| | - Peter Bárány
- Department of Renal Medicine , Karolinska University Hospital , Stockholm , Sweden
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Molnár C, Essand M, Wennberg L, Berne C, Larsson E, Tufveson G, Korsgren O. Islet Engraftment and Revascularization in Clinical and Experimental Transplantation. Cell Transplant 2013; 22:243-51. [DOI: 10.3727/096368912x640637] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Proper revascularization after transplantation is assumed to be crucial for appropriate islet graft function. We developed a novel noninvasive imaging method, based on adenoviral transduction of islets with a hypoxia responsive reporter gene, for continuous in vivo monitoring of hypoxia in islet grafts in a mouse model. In addition, morphological data were obtained from a deceased patient previously subject to intraportal transplantation. We detected only transient hypoxia in a minority of the animals transplanted. Importantly, a clear response to hypoxia was observed in vitro after removal of the islet grafts on day 28 after transplantation. Also, the morphological data from the deceased patient demonstrated an extensive revascularization of the transplanted islets. In fact, no differences could be seen between native islets, in pancreas biopsies taken prior to islet isolation, and transplanted islets regarding the number, distribution, and shape of the blood vessels. However, fewer small islets (diameter <39 μm) were found in the liver compared to those found in native pancreases. Notably, an absolute majority of the transplanted islets were found remaining within the venous lumen, in direct contact with the vessel wall. In conclusion, the results presented show less pronounced islet graft hypoxia after subcapsular transplantation than previously reported using more invasive methods. Also, formation of an extensive intraislet capillary network, similar to that seen in native islets in the pancreas, was seen after clinical islet transplantation.
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Affiliation(s)
- Christian Molnár
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Department of Transplantation Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Essand
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Lars Wennberg
- Department of Transplantation Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Christian Berne
- Department of Medical Sciences, Division of Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Erik Larsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Gunnar Tufveson
- Department of Surgical Sciences, Division of Transplantation Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Olle Korsgren
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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Asif S, Sedigh A, Nordström J, Brandhorst H, Jorns C, Lorant T, Larsson E, Magnusson PU, Nowak G, Theisinger S, Hoeger S, Wennberg L, Korsgren O, Brandhorst D. Oxygen-charged HTK-F6H8 emulsion reduces ischemia-reperfusion injury in kidneys from brain-dead pigs. J Surg Res 2012; 178:959-67. [PMID: 22795349 DOI: 10.1016/j.jss.2012.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 06/14/2012] [Accepted: 06/15/2012] [Indexed: 01/02/2023]
Abstract
BACKGROUND Prolonged cold ischemia is frequently associated with a greater risk of delayed graft function and enhanced graft failure. We hypothesized that media, combining a high oxygen-dissolving capacity with specific qualities of organ preservation solutions, would be more efficient in reducing immediate ischemia-reperfusion injury from organs stored long term compared with standard preservation media. METHODS Kidneys retrieved from brain-dead pigs were flushed using either cold histidine-tryptophan-ketoglutarate (HTK) or oxygen-precharged emulsion composed of 75% HTK and 25% perfluorohexyloctane. After 18 h of cold ischemia the kidneys were transplanted into allogeneic recipients and assessed for adenosine triphosphate content, morphology, and expression of genes related to hypoxia, environmental stress, inflammation, and apoptosis. RESULTS Compared with HTK-flushed kidneys, organs preserved using oxygen-precharged HTK-perfluorohexyloctane emulsion had increased elevated adenosine triphosphate content and a significantly lower gene expression of hypoxia inducible factor-1α, vascular endothelial growth factor, interleukin-1α, tumor necrosis factor-α, interferon-α, JNK-1, p38, cytochrome-c, Bax, caspase-8, and caspase-3 at all time points assessed. In contrast, the mRNA expression of Bcl-2 was significantly increased. CONCLUSIONS The present study has demonstrated that in brain-dead pigs the perfusion of kidneys with oxygen-precharged HTK-perfluorohexyloctane emulsion results in significantly reduced inflammation, hypoxic injury, and apoptosis and cellular integrity and energy content are well maintained. Histologic examination revealed less tubular, vascular, and glomerular changes in the emulsion-perfused tissue compared with the HTK-perfused counterparts. The concept of perfusing organs with oxygen-precharged emulsion based on organ preservation media represents an efficient alternative for improved organ preservation.
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Affiliation(s)
- Sana Asif
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
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Genberg H, Kumlien G, Wennberg L, Tyden G. The efficacy of antigen-specific immunoadsorption and rebound of anti-A/B antibodies in ABO-incompatible kidney transplantation. Nephrol Dial Transplant 2011; 26:2394-400. [PMID: 21558429 DOI: 10.1093/ndt/gfr237] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND As antigen-specific immunoadsorption (IA) using the Glycosorb®-ABO columns is becoming increasingly popular in ABO-incompatible (ABOi) transplantation, in this study, we retrospectively investigated the efficacy of Glycosorb®-ABO IA in vivo and ex vivo. We also assessed the risk of anti-A/B antibody (ABab) rebound before and after ABOi kidney transplantation. METHODS A protocol for ABOi living donor kidney transplantation was used, combining four preoperative and three preemptive postoperative Glycosorb®-ABO IAs with rituximab and maintenance immunosuppression. ABabs were determined by a haemagglutination titration technique. RESULTS ABOi kidney transplantation was attempted 45 times and 43 transplantations were performed. Overall patient survival was 93% and graft survival was 91%. Mean follow-up was 4.5 years. Glycosorb®-ABO IA significantly reduced the ABabs in the majority of patients (P < 0.0001). However, in three patients (6.8%), the antibody elimination was incomplete. Inadequate adsorption of core-chain-dependent ABabs may explain this finding, but further studies are needed. In five patients, the preconditioning was interrupted before transplantation, resulting in ABab rebound. Yet, when preconditioning was restarted, the antibodies could be removed as planned. After ABOi transplantation, rebound of ABabs was seen in two patients (5%). CONCLUSIONS Glycosorb®-ABO IA in combination with rituximab effectively depletes ABabs in most patients, but owing to core-chain-dependent ABabs, Glycosorb®-ABO IA may be less effective than nonspecific techniques for antibody removal in some patients. Rebound before transplantation subsequent to interrupted preconditioning does not hamper a successful ABOi transplantation. Postoperatively, when this protocol for ABOi transplantation is followed, the risk of ABab rebound is small.
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Affiliation(s)
- Helena Genberg
- Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden.
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Abstract
As the demand for kidney transplantation is constantly growing methods to expand the donor pool have become increasingly important. ABO-incompatibility has hitherto been regarded as an absolute contraindication to living donor donation. However, as ABO-incompatibility has accounted for the majority of living donor exclusions, efforts have been made to overcome this immunologic barrier. Successful desensitization protocols thus far, have combined plasmapheresis for antibody removal with splenectomy to reduce the antibody producing B-cell pool, in addition to quadruple immunosuppression. Although good graft function has been achieved, the high risks involved have been deterrent. We have developed a protocol for ABO-incompatible kidney transplantation based on antigen-specific immunoadsorption and rituximab, in combination with standard maintenance immunosuppression (tacrolimus, mycophenolate mofetil and corticosteroids). We hypothesized that the anti-A/B antibodies could be effectively eliminated and good graft function achieved, without the complications of coagulopathy and transfusion reactions associated with plasmapheresis. Furthermore, we hypothesized that the substitution of splenectomy with a single dose of the anti-CD20 antibody rituximab would further reduce surgical risk as well as the risk of infectious complications. In 2001 the program for ABO-incompatible kidney transplantation was started at our center. To date 50 ABO-incompatible kidney transplantations have been performed according to the protocol based on antigen-specific immunoadsorption and rituximab. Safety and efficacy of the protocol has been evaluated in several studies, all showing that the antigen-specific immunoadsorption is well tolerated and without any serious side effects. Patient and graft survival as well as kidney function have been comparable to that of ABO-compatible living donor kidney transplantation and the incidence of antibody-mediated rejection 0%. We conclude that AB0-incompatible kidney transplantation using a protocol based on antigen-specific immunoadsorption and rituximab, in combination with triple immunosuppressive therapy is safe and effective. ABO-incompatibility following this protocol does not have a negative impact on graft function. ABO-incompatible kidney transplantation is equivalent to standard ABO-compatible living donor kidney transplantation.
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Affiliation(s)
- Helena Genberg
- Department of Transplantation Surgery, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden.
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Elinder CG, Ekberg H, Bárány P, Fehrman-Ekholm I, Jensen G, Nordén G, Schön S, Wennberg L, Qureshi AR. Variations in graft and patient survival after kidney transplantation in Sweden: caveats in interpretation of center effects when benchmarking. Transpl Int 2009; 22:1051-7. [DOI: 10.1111/j.1432-2277.2009.00894.x] [Citation(s) in RCA: 6] [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: 11/28/2022]
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