1
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Nieuwenhuijs-Moeke GJ, Nieuwenhuijs VB, Seelen MAJ, Berger SP, van den Heuvel MC, Burgerhof JGM, Ottens PJ, Ploeg RJ, Leuvenink HGD, Struys MMRF. Propofol-based anaesthesia versus sevoflurane-based anaesthesia for living donor kidney transplantation: results of the VAPOR-1 randomized controlled trial. Br J Anaesth 2018; 118:720-732. [PMID: 28510740 DOI: 10.1093/bja/aex057] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 12/22/2022] Open
Abstract
Background Kidney transplantation is associated with harmful processes affecting the viability of the graft. One of these processes is associated with the phenomenon of ischaemia-reperfusion injury. Anaesthetic conditioning is a widely described strategy to attenuate ischaemia-reperfusion injury. We therefore conducted the Volatile Anaesthetic Protection of Renal Transplants-1 trial, a pilot project evaluating the influence of two anaesthetic regimens, propofol- vs sevoflurane-based anaesthesia, on biochemical and clinical outcomes in living donor kidney transplantation. Methods Sixty couples were randomly assigned to the following three groups: PROP (donor and recipient propofol), SEVO (donor and recipient sevoflurane), and PROSE (donor propofol and recipient sevoflurane). The primary outcome was renal injury reflected by urinary biomarkers. The follow-up period was 2 yr. Results Three couples were excluded, leaving 57 couples for analysis. Concentrations of kidney injury molecule-1 (KIM-1), N -acetyl-β- d -glucosaminidase (NAG), and heart-type fatty acid binding protein (H-FABP) in the first urine upon reperfusion showed no differences. On day 2, KIM-1 concentrations were higher in SEVO [952.8 (interquartile range 311.8-1893.0) pg mmol -1 ] compared with PROP [301.2 (202.0-504.7) pg mmol -1 ]. This was the same for NAG: SEVO, 1.835 (1.162-2.457) IU mmol -1 vs PROP, 1.078 (0.819-1.713) IU mmol -1 . Concentrations of H-FABP showed no differences. Measured glomerular filtration rate at 3, 6, and 12 months showed no difference. After 2 yr, there was a difference in the acute rejection rate ( P =0.039). Post hoc testing revealed a difference between PROP (35%) and PROSE (5%; P =0.020). The difference between PROP and SEVO (11%) was not significant ( P =0.110). Conclusions The SEVO group showed higher urinary KIM-1 and NAG concentrations in living donor kidney transplantation on the second day after transplantation. This was not reflected in inferior graft outcome. Clinical trial registration NCT01248871.
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Affiliation(s)
| | - V B Nieuwenhuijs
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Surgery, Isala, Zwolle, The Netherlands
| | | | | | | | - J G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - P J Ottens
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - R J Ploeg
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - H G D Leuvenink
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - M M R F Struys
- Department of Anaesthesiology.,Department of Anaesthesia, Ghent University, Ghent, Belgium
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2
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Kamburova EG, Wisse BW, Joosten I, Allebes WA, van der Meer A, Hilbrands LB, Baas MC, Spierings E, Hack CE, van Reekum FE, van Zuilen AD, Verhaar MC, Bots ML, Drop ACAD, Plaisier L, Seelen MAJ, Sanders JS.F, Hepkema BG, Lambeck AJA, Bungener LB, Roozendaal C, Tilanus MGJ, Voorter CE, Wieten L, van Duijnhoven EM, Gelens M, Christiaans MHL, van Ittersum FJ, Nurmohamed SA, Lardy NM, Swelsen W, van der Pant KA, van der Weerd NC, ten Berge IJM, Bemelman FJ, Hoitsma A, van der Boog PJM, de Fijter JW, Betjes MGH, Heidt S, Roelen DL, Claas FH, Otten HG. Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant. Am J Transplant 2018; 18:2274-2284. [PMID: 29464832 PMCID: PMC6175247 DOI: 10.1111/ajt.14709] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 01/25/2023]
Abstract
The presence of donor-specific anti-HLA antibodies (DSAs) is associated with increased risk of graft failure after kidney transplant. We hypothesized that DSAs against HLA class I, class II, or both classes indicate a different risk for graft loss between deceased and living donor transplant. In this study, we investigated the impact of pretransplant DSAs, by using single antigen bead assays, on long-term graft survival in 3237 deceased and 1487 living donor kidney transplants with a negative complement-dependent crossmatch. In living donor transplants, we found a limited effect on graft survival of DSAs against class I or II antigens after transplant. Class I and II DSAs combined resulted in decreased 10-year graft survival (84% to 75%). In contrast, after deceased donor transplant, patients with class I or class II DSAs had a 10-year graft survival of 59% and 60%, respectively, both significantly lower than the survival for patients without DSAs (76%). The combination of class I and II DSAs resulted in a 10-year survival of 54% in deceased donor transplants. In conclusion, class I and II DSAs are a clear risk factor for graft loss in deceased donor transplants, while in living donor transplants, class I and II DSAs seem to be associated with an increased risk for graft failure, but this could not be assessed due to their low prevalence.
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3
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Eskandari SK, Seelen MAJ, Lin G, Azzi JR. The immunoproteasome: An old player with a novel and emerging role in alloimmunity. Am J Transplant 2017; 17:3033-3039. [PMID: 28719024 DOI: 10.1111/ajt.14435] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 04/16/2017] [Revised: 06/20/2017] [Accepted: 07/06/2017] [Indexed: 01/25/2023]
Abstract
Modern treatment strategies for the maintenance of allograft acceptance frequently target ubiquitously-expressed pathways, leading to significant side-effects and poor long-term allograft outcomes. Constitutive proteasome inhibitors, which have recently been introduced for the treatment of antibody-mediated rejection, target the ubiquitously-expressed proteasome. To limit off-target effects and serious mechanism-based toxicity, however, these inhibitors are administered intermittently and suboptimally. Immunoproteasomes, which are an inducible subset of proteasomes enriched in immune cells, replace constitutive proteasomes after cell exposure to proinflammatory cytokines such as interferon-γ. While immunoproteasomes were first described as processors of antigen for presentation by major histocompatibility complex molecules, recent findings point to its broader biological roles. These vary from activating different subsets of the immune system, by controlling transcriptional activators and downstream cytokines, to affecting their differentiation and survival. These emerging roles of the immunoproteasome in activated immune cells have made it a rational candidate for the targeted treatment of immune-mediated diseases. Preclinical studies have established its role in maintaining allograft acceptance without significant short- or long-term toxicity. This review provides a brief background of the immunoproteasome and outlines its role in immunological pathways and its potential in alloimmunity.
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Affiliation(s)
- S K Eskandari
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M A J Seelen
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G Lin
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, NY, USA
| | - J R Azzi
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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4
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Kamburova EG, Wisse BW, Joosten I, Allebes WA, van der Meer A, Hilbrands LB, Baas MC, Spierings E, Hack CE, van Reekum FE, van Zuilen AD, Verhaar M, Bots ML, Drop ACAD, Plaisier L, Seelen MAJ, Sanders JSF, Hepkema BG, Lambeck AJ, Bungener LB, Roozendaal C, Tilanus MGJ, Vanderlocht J, Voorter CE, Wieten L, van Duijnhoven EM, Gelens M, Christiaans MHL, van Ittersum FJ, Nurmohamed A, Lardy NM, Swelsen W, van der Pant KA, van der Weerd NC, Ten Berge IJM, Bemelman FJ, Hoitsma A, van der Boog PJM, de Fijter JW, Betjes MGH, Heidt S, Roelen DL, Claas FH, Otten HG. How can we reduce costs of solid-phase multiplex-bead assays used to determine anti-HLA antibodies? HLA 2016; 88:110-9. [PMID: 27534609 DOI: 10.1111/tan.12860] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/24/2016] [Indexed: 11/29/2022]
Abstract
Solid-phase multiplex-bead assays are widely used in transplantation to detect anti-human leukocyte antigen (HLA) antibodies. These assays enable high resolution detection of low levels of HLA antibodies. However, multiplex-bead assays are costly and yield variable measurements that limit the comparison of results between laboratories. In the context of a Dutch national Consortium study we aimed to determine the inter-assay and inter-machine variability of multiplex-bead assays, and we assessed how to reduce the assay reagents costs. Fifteen sera containing a variety of HLA antibodies were used yielding in total 7092 median fluorescence intensities (MFI) values. The inter-assay and inter-machine mean absolute relative differences (MARD) of the screening assay were 12% and 13%, respectively. The single antigen bead (SAB) inter-assay MARD was comparable, but showed a higher lot-to-lot variability. Reduction of screening assay reagents to 50% or 40% of manufacturers' recommendations resulted in MFI values comparable to 100% of the reagents, with an MARD of 12% or 14%, respectively. The MARD of the 50% and 40% SAB assay reagent reductions were 11% and 22%, respectively. From this study, we conclude that the reagents can be reliably reduced at least to 50% of manufacturers' recommendations with virtually no differences in HLA antibody assignments.
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Affiliation(s)
- E G Kamburova
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B W Wisse
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I Joosten
- Laboratory Medicine, Lab. Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - W A Allebes
- Laboratory Medicine, Lab. Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A van der Meer
- Laboratory Medicine, Lab. Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M C Baas
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E Spierings
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C E Hack
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F E van Reekum
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A D van Zuilen
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Verhaar
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A C A D Drop
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Plaisier
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M A J Seelen
- Department of Nephrology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - J S F Sanders
- Department of Nephrology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - B G Hepkema
- Department of Laboratory Medicine, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - A J Lambeck
- Department of Laboratory Medicine, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - L B Bungener
- Department of Laboratory Medicine, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - C Roozendaal
- Department of Laboratory Medicine, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - M G J Tilanus
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Vanderlocht
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C E Voorter
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L Wieten
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E M van Duijnhoven
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M Gelens
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M H L Christiaans
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - F J van Ittersum
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands
| | - A Nurmohamed
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands
| | - N M Lardy
- Department of Immunogenetics, Sanquin, Amsterdam, The Netherlands
| | - W Swelsen
- Department of Immunogenetics, Sanquin, Amsterdam, The Netherlands
| | - K A van der Pant
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - N C van der Weerd
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - I J M Ten Berge
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - F J Bemelman
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - A Hoitsma
- Dutch Organ Transplant Registry (NOTR), Dutch Transplant Foundation (NTS), Leiden, The Netherlands
| | - P J M van der Boog
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - J W de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - M G H Betjes
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.,Department of Nephrology, Erasmus MC, Rotterdam, The Netherlands
| | - S Heidt
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - D L Roelen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - F H Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - H G Otten
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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5
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Poppelaars F, Damman J, de Vrij EL, Burgerhof JGM, Saye J, Daha MR, Leuvenink HG, Uknis ME, Seelen MAJ. New insight into the effects of heparinoids on complement inhibition by C1-inhibitor. Clin Exp Immunol 2016; 184:378-88. [PMID: 26874675 DOI: 10.1111/cei.12777] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 01/22/2023] Open
Abstract
Complement activation is of major importance in numerous pathological conditions. Therefore, targeted complement inhibition is a promising therapeutic strategy. C1-esterase inhibitor (C1-INH) controls activation of the classical pathway (CP) and the lectin pathway (LP). However, conflicting data exist on inhibition of the alternative pathway (AP) by C1-INH. The inhibitory capacity of C1-INH for the CP is potentiated by heparin and other glycosaminoglycans, but no data exist for the LP and AP. The current study investigates the effects of C1-INH in the presence or absence of different clinically used heparinoids on the CP, LP and AP. Furthermore, the combined effects of heparinoids and C1-INH on coagulation were investigated. C1-INH, heparinoids or combinations were analysed in a dose-dependent fashion in the presence of pooled serum. Functional complement activities were measured simultaneously using the Wielisa(®) -kit. The activated partial thrombin time was determined using an automated coagulation analyser. The results showed that all three complement pathways were inhibited significantly by C1-INH or heparinoids. Next to their individual effects on complement activation, heparinoids also enhanced the inhibitory capacity of C1-INH significantly on the CP and LP. For the AP, significant potentiation of C1-INH by heparinoids was found; however, this was restricted to certain concentration ranges. At low concentrations the effect on blood coagulation by combining heparinoids with C1-INH was minimal. In conclusion, our study shows significant potentiating effects of heparinoids on the inhibition of all complement pathways by C1-INH. Therefore, their combined use is a promising and a potentially cost-effective treatment option for complement-mediated diseases.
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Affiliation(s)
- F Poppelaars
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groninge, Groningen
| | - J Damman
- Department of Pathology, University of Amsterdam, Academic Medical Centre, Amsterdam
| | - E L de Vrij
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - J Saye
- ViroPharma, Inc., Exton, PA, USA
| | - M R Daha
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groninge, Groningen.,Department of Nephrology, University of Leiden, Leiden University Medical Center, Leiden
| | - H G Leuvenink
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - M A J Seelen
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groninge, Groningen
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6
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Otten HG, Joosten I, Allebes WA, van der Meer A, Hilbrands LB, Baas M, Spierings E, Hack CE, van Reekum F, van Zuilen AD, Verhaar MC, Bots ML, Seelen MAJ, Sanders JSF, Hepkema BG, Lambeck AJ, Bungener LB, Roozendaal C, Tilanus MGJ, Vanderlocht J, Voorter CE, Wieten L, van Duijnhoven E, Gelens M, Christiaans M, van Ittersum F, Nurmohamed A, Lardy NM, Swelsen WT, van Donselaar-van der Pant KAMI, van der Weerd NC, Ten Berge IJM, Bemelman FJ, Hoitsma AJ, de Fijter JW, Betjes MGH, Roelen DL, Claas FHJ. The PROCARE consortium: toward an improved allocation strategy for kidney allografts. Transpl Immunol 2014; 31:184-90. [PMID: 25258025 DOI: 10.1016/j.trim.2014.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Kidney transplantation is the best treatment option for patients with end-stage renal failure. At present, approximately 800 Dutch patients are registered on the active waiting list of Eurotransplant. The waiting time in the Netherlands for a kidney from a deceased donor is on average between 3 and 4 years. During this period, patients are fully dependent on dialysis, which replaces only partly the renal function, whereas the quality of life is limited. Mortality among patients on the waiting list is high. In order to increase the number of kidney donors, several initiatives have been undertaken by the Dutch Kidney Foundation including national calls for donor registration and providing information on organ donation and kidney transplantation. The aim of the national PROCARE consortium is to develop improved matching algorithms that will lead to a prolonged survival of transplanted donor kidneys and a reduced HLA immunization. The latter will positively affect the waiting time for a retransplantation. The present algorithm for allocation is among others based on matching for HLA antigens, which were originally defined by antibodies using serological typing techniques. However, several studies suggest that this algorithm needs adaptation and that other immune parameters which are currently not included may assist in improving graft survival rates. We will employ a multicenter-based evaluation on 5429 patients transplanted between 1995 and 2005 in the Netherlands. The association between key clinical endpoints and selected laboratory defined parameters will be examined, including Luminex-defined HLA antibody specificities, T and B cell epitopes recognized on the mismatched HLA antigens, non-HLA antibodies, and also polymorphisms in complement and Fc receptors functionally associated with effector functions of anti-graft antibodies. From these data, key parameters determining the success of kidney transplantation will be identified which will lead to the identification of additional parameters to be included in future matching algorithms aiming to extend survival of transplanted kidneys and to diminish HLA immunization. Computer simulation studies will reveal the number of patients having a direct benefit from improved matching, the effect on shortening of the waiting list, and the decrease in waiting time.
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Affiliation(s)
- H G Otten
- UMC Utrecht, Laboratory for Translational Immunology, The Netherlands
| | - I Joosten
- Radboudumc, Dept. of Laboratory Medicine, The Netherlands
| | - W A Allebes
- Radboudumc, Dept. of Laboratory Medicine, The Netherlands
| | - A van der Meer
- Radboudumc, Dept. of Laboratory Medicine, The Netherlands
| | | | - M Baas
- Radboudumc, Dept. of Nephrology, The Netherlands
| | - E Spierings
- UMC Utrecht, Laboratory for Translational Immunology, The Netherlands
| | - C E Hack
- UMC Utrecht, Laboratory for Translational Immunology, The Netherlands
| | - F van Reekum
- UMC Utrecht, Dept. of Nephrology and Hypertension, The Netherlands
| | - A D van Zuilen
- UMC Utrecht, Dept. of Nephrology and Hypertension, The Netherlands
| | - M C Verhaar
- UMC Utrecht, Dept. of Nephrology and Hypertension, The Netherlands
| | - M L Bots
- UMC Utrecht, Julius Center for Health Sciences and Primary Care, The Netherlands
| | | | | | - B G Hepkema
- UMCG, Dept. of Laboratory Medicine, The Netherlands
| | - A J Lambeck
- UMCG, Dept. of Laboratory Medicine, The Netherlands
| | - L B Bungener
- UMCG, Dept. of Laboratory Medicine, The Netherlands
| | - C Roozendaal
- UMCG, Dept. of Laboratory Medicine, The Netherlands
| | - M G J Tilanus
- Maastricht UMC, Transplantation Immunology, The Netherlands
| | - J Vanderlocht
- Maastricht UMC, Transplantation Immunology, The Netherlands
| | - C E Voorter
- Maastricht UMC, Transplantation Immunology, The Netherlands
| | - L Wieten
- Maastricht UMC, Transplantation Immunology, The Netherlands
| | | | - M Gelens
- Maastricht UMC, Dept. of Nephrology, The Netherlands
| | - M Christiaans
- Maastricht UMC, Dept. of Nephrology, The Netherlands
| | | | | | - N M Lardy
- Sanquin, Dept. of Immunogenetics, The Netherlands
| | - W T Swelsen
- Sanquin, Dept. of Immunogenetics, The Netherlands
| | | | | | - I J M Ten Berge
- AMC Renal Transplant Unit, Dept. of Nephrology, The Netherlands
| | - F J Bemelman
- AMC Renal Transplant Unit, Dept. of Nephrology, The Netherlands
| | | | | | - M G H Betjes
- Erasmus MC, Dept. of Nephrology, The Netherlands
| | - D L Roelen
- LUMC, Immunohematology and Blood Transfusion, The Netherlands
| | - F H J Claas
- LUMC, Immunohematology and Blood Transfusion, The Netherlands
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7
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van Werkhoven MB, Damman J, van Dijk MCRF, Daha MR, de Jong IJ, Leliveld A, Krikke C, Leuvenink HG, van Goor H, van Son WJ, Olinga P, Hillebrands JL, Seelen MAJ. Complement mediated renal inflammation induced by donor brain death: role of renal C5a-C5aR interaction. Am J Transplant 2013; 13:875-882. [PMID: 23398742 DOI: 10.1111/ajt.12130] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 11/26/2012] [Accepted: 12/10/2012] [Indexed: 01/25/2023]
Abstract
Kidneys retrieved from brain-dead donors have impaired allograft function after transplantation compared to kidneys from living donors. Donor brain death (BD) triggers inflammatory responses, including both systemic and local complement activation. The mechanism by which systemic activated complement contributes to allograft injury remains to be elucidated. The aim of this study was to investigate systemic C5a release after BD in human donors and direct effects of C5a on human renal tissue. C5a levels were measured in plasma from living and brain-dead donors. Renal C5aR gene and protein expression in living and brain-dead donors was investigated in renal pretransplantation biopsies. The direct effect of C5a on human renal tissue was investigated by stimulating human kidney slices with C5a using a newly developed precision-cut method. Elevated C5a levels were found in plasma from brain-dead donors in concert with induced C5aR expression in donor kidney biopsies. Exposure of precision-cut human kidney slices to C5a induced gene expression of pro-inflammatory cytokines IL-1 beta, IL-6 and IL-8. In conclusion, these findings suggest that systemic generation of C5a mediates renal inflammation in brain-dead donor grafts via tubular C5a-C5aR interaction. This study also introduces a novel in vitro technique to analyze renal cells in their biological environment.
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Affiliation(s)
- M B van Werkhoven
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J Damman
- Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M C R F van Dijk
- Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M R Daha
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - I J de Jong
- Department of Urology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A Leliveld
- Department of Urology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - C Krikke
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - H G Leuvenink
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - H van Goor
- Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - W J van Son
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - P Olinga
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, the Netherlands
| | - J-L Hillebrands
- Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M A J Seelen
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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