1
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Donadeu L, Jouve T, Bin S, Hartzell S, Crespo E, Torija A, Jarque M, Kevella D, Zúñiga J, Zhang W, Sun Z, Verlato A, Martínez-Gallo M, Font-Miñarro C, Meneghini M, Toapanta N, Torres IB, Sellarés J, Perelló M, Kaminski H, Couzi L, Loupy A, La Manna G, Moreso F, Cravedi P, Bestard O. High-dimensional Mass Cytometry identified circulating Natural Killer T-cell subsets associated with protection from Cytomegalovirus infection in kidney transplant recipients. Kidney Int 2024:S0085-2538(24)00310-7. [PMID: 38685562 DOI: 10.1016/j.kint.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/08/2024] [Accepted: 03/12/2024] [Indexed: 05/02/2024]
Abstract
Cytomegalovirus (CMV) infection is associated with poor kidney transplant outcomes. While innate and adaptive immune cells have been implicated in its prevention, an in-depth characterization of the in vivo kinetics of multiple cell subsets and their role in protecting against CMV infection has not been achieved. Here, we performed high-dimensional immune phenotyping by mass cytometry, and functional assays, on 112 serially collected samples from CMV seropositive kidney transplant recipients. Advanced unsupervised deep learning analysis was used to assess immune cell populations that significantly correlated with prevention against CMV infection and anti-viral immune function. Prior to infection, kidney transplant recipients who developed CMV infection showed significantly lower CMV-specific cell-mediated immune (CMI) frequencies than those that did not. A broad diversity of circulating cell subsets within innate and adaptive immune compartments were associated with CMV infection or protective CMV-specific CMI. While percentages of CMV (tetramer-stained)-specific T cells associated with high CMI responses and clinical protection, circulating CD3+CD8midCD56+ NK-T cells overall strongly associated with low CMI and subsequent infection. However, three NK-T cell subsets sharing the CD11b surface marker associated with CMV protection and correlated with strong anti-viral CMI frequencies in vitro. These data were validated in two external independent cohorts of kidney transplant recipients. Thus, we newly describe the kinetics of a novel NK-T cell subset that may have a protective role in post-transplantation CMV infection. Our findings pave the way to more mechanistic studies aimed at understanding the function of these cells in protection against CMV infection.
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Affiliation(s)
- Laura Donadeu
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thomas Jouve
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Univ. Grenoble Alpes, CHU Grenoble Alpes, Inserm 1209, CNRS 5309, IAB, Grenoble
| | - Sofia Bin
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA; Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Susan Hartzell
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA
| | - Elena Crespo
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Torija
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Jarque
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Delphine Kevella
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Zúñiga
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Weijia Zhang
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA
| | - Zeguo Sun
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alberto Verlato
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mónica Martínez-Gallo
- Immunology department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Font-Miñarro
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Meneghini
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nestor Toapanta
- Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irina B Torres
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joana Sellarés
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Perelló
- Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hannah Kaminski
- Department of Nephrology, Transplantation, Dialysis and Apheresis, CHU Bordeaux, Bordeaux, France; UMR 5164-ImmunoConcEpT, University of Bordeaux, CNRS, Bordeaux University, Bordeaux, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis and Apheresis, CHU Bordeaux, Bordeaux, France; UMR 5164-ImmunoConcEpT, University of Bordeaux, CNRS, Bordeaux University, Bordeaux, France
| | - Alexandre Loupy
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale UMR-S970, Université de Paris, Paris, France
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesc Moreso
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paolo Cravedi
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA.
| | - Oriol Bestard
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.
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2
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Terrades NR, Senin A, Azancot MA, Gironella M, Toapanta N, Bermejo S, Martin L, Caravaca-Fontán F, Cuellar C, Martínez-Lopez J, Rodríguez E, Bestard O, Soler MJ. Role of light chain clearance in the recovery of renal function in multiple myeloma: another point of view. Clin Kidney J 2023; 16:1014-1021. [PMID: 37260999 PMCID: PMC10229297 DOI: 10.1093/ckj/sfad022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) in patients with multiple myeloma (MM) requiring renal replacement treatment (RRT) is associated with high morbidity and mortality. Early reduction of serum free light chains (FLC) using both targeted therapy against MM and intensive hemodialysis (IHD) may improve renal outcomes. We evaluated the effectiveness of two different RRT techniques on renal recovery in an MM patient population: standard dialysis procedure vs IHD with either polymethylmethacrylate (PMMA) or hemodiafiltration with endogenous reinfusion (HFR). METHODS This was a multicentric retrospective study with severe AKI related to MM, between 2011 and 2018. Twenty-five consecutive patients with AKI secondary to MM requiring RRT were included. Patients that underwent IHD received six dialysis sessions per week during the first 14 days (PMMA vs HFR). All patients were diagnosed with de novo MM or first relapsed MM. Primary outcome was renal recovery defined as dialysis-free at 6 months follow-up. RESULTS A total of 25 patients were included. Seventeen patients received IHD and eight standard dialysis. All patients were treated with targeted therapy, 84% bortezomib-based. Of the 25 patients included, 14 (56%) became dialysis independent. We observed a higher proportion of patients who received IHD in the group who recovered kidney function compared with those who remained in HD (92.9% vs 36.4%, P = .007). In our study, the use of IHD to remove FLC had a statistically significant association with renal recovery compared with the standard dialysis group (P = .024). CONCLUSION Early reduction of FLC with IHD as an adjuvant treatment along with MM-targeted therapy may exert a positive impact on renal recovery.
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Affiliation(s)
| | - Alicia Senin
- Hospital Duran i Reynalds, ICO, Hospitalet, Spain
| | - Maria A Azancot
- Department of Nephrology, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Nestor Toapanta
- Department of Nephrology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Sheila Bermejo
- Department of Nephrology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Lucia Martin
- Department of Hematology, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Clara Cuellar
- Department of Hematology, Hospital 12 de Octubre, Madrid, Spain
| | | | - Eva Rodríguez
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Oriol Bestard
- Department of Nephrology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Maria Jose Soler
- Department of Nephrology, Hospital Vall d'Hebron, Barcelona, Spain
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3
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Zamora JI, López-Martínez M, Patricio Liebana M, Leon Román JC, Bermejo S, Vergara A, Agraz I, Terrades NR, Azancot MA, Toapanta N, Gabaldon MA, Soler MJ. Epidemiology of Immune-Mediated Glomerulopathies before and after SARS-CoV-2 Vaccination: A Tertiary Referral Hospital Experience. J Clin Med 2023; 12:jcm12062420. [PMID: 36983419 PMCID: PMC10056116 DOI: 10.3390/jcm12062420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/08/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Vaccination is a known trigger for the appearance of immune-mediated glomerulopathies (IMG). The appearance of IMG after SARS-CoV-2 vaccination with suspected causality has been described. Our aim is to analyze the incidence of IMG flares before and after SARS-CoV-2 vaccination in our center. METHODS All persons with native kidney biopsy (KB) from January 2019 to March 2022 in our center were included in the study. We compared the incidence of IMG before and after the start of vaccination. We also collected information about whether the patients had received a SARS-CoV-2 vaccine or have suffered from COVID in the six weeks before the IMG. We also evaluated the analytical characteristics of the outbreaks. RESULTS A total of 386 KB were studied. Of them, 86/218 (39.4%) were IMG performed pre- and 85/168 (50.6%) post-SV (029). The incidence of idiopathic nephrotic syndrome (INS), studied separately, was also significantly increased post-vaccination (n = 18 (10.7%)) compared to pre-vaccination (n = 11 (5%)) (p = 0.036). There were no differences in the incidence of vasculitis or IgA nephropathy. Up to 17 (20%) flares occurred 6 weeks before SARS-CoV-2 vaccination and only 2 (2.4%) within the first 6 weeks after SARS-CoV-2 infection. Within those 17 flares, the most common diagnosis was IgAN (n = 5 (29.4%)); a total of 14 (82.4%) received an mRNA vaccine and 9 (52.9%) took place after the 1st vaccine dose. There were 13 cases of minimal change disease (MCD) with debut/recurrence pre-SV and 20 MCD with debut/recurrence post-SV (p = 0.002). CONCLUSIONS The incidence of IMG, INS and MCD flares in our center increased significantly after SARS-CoV-2 vaccination. Importantly, 20% of IMG flares took place within the first 6 weeks after receiving a vaccine dose, with the first dose being the riskiest one and IgAN the most frequent diagnosis.
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Affiliation(s)
- Jorge Iván Zamora
- Department of Nephrology, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d'Hebron University Hospital, 08036 Barcelona, Spain
| | - Marina López-Martínez
- Department of Nephrology, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d'Hebron University Hospital, 08036 Barcelona, Spain
| | - Marc Patricio Liebana
- Department of Nephrology, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d'Hebron University Hospital, 08036 Barcelona, Spain
| | - Juan Carlos Leon Román
- Department of Nephrology, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d'Hebron University Hospital, 08036 Barcelona, Spain
| | - Sheila Bermejo
- Department of Nephrology, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d'Hebron University Hospital, 08036 Barcelona, Spain
| | - Ander Vergara
- Department of Nephrology, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d'Hebron University Hospital, 08036 Barcelona, Spain
| | - Irene Agraz
- Department of Nephrology, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d'Hebron University Hospital, 08036 Barcelona, Spain
| | - Natalia Ramos Terrades
- Department of Nephrology, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d'Hebron University Hospital, 08036 Barcelona, Spain
| | - Maria Antonieta Azancot
- Department of Nephrology, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d'Hebron University Hospital, 08036 Barcelona, Spain
| | - Nestor Toapanta
- Department of Nephrology, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d'Hebron University Hospital, 08036 Barcelona, Spain
| | - Maria Alejandra Gabaldon
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d'Hebron University Hospital, 08036 Barcelona, Spain
- Department of Pathology, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
| | - Maria José Soler
- Department of Nephrology, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d'Hebron University Hospital, 08036 Barcelona, Spain
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4
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Lopez-Martinez M, Torres I, Bermejo S, Moreso F, Garcia-Carro C, Vergara A, Ramos N, Perello M, Gabaldon A, Azancot MA, Bolufer M, Toapanta N, Bestard O, Agraz-Pamplona I, Soler MJ. Corrigendum: Enteric Budesonide in Transplant and Native IgA Nephropathy: Real-World Clinical Practice. Transpl Int 2023; 35:11073. [PMID: 36685666 PMCID: PMC9849238 DOI: 10.3389/ti.2022.11073] [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: 11/22/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023]
Abstract
[This corrects the article DOI: 10.3389/ti.2022.10693.].
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Affiliation(s)
- Marina Lopez-Martinez
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Irina Torres
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Sheila Bermejo
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Francesc Moreso
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain,*Correspondence: Francesc Moreso, ; Maria Jose Soler,
| | - Clara Garcia-Carro
- Department of Nephrology, San Carlos Clinical University Hospital, Madrid, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), San Carlos Clinical University Hospital, Madrid, Spain
| | - Ander Vergara
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Natalia Ramos
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Manel Perello
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Alejandra Gabaldon
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain,Department of Pathology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - M. Antonieta Azancot
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Monica Bolufer
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Nestor Toapanta
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Oriol Bestard
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Irene Agraz-Pamplona
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Maria Jose Soler
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain,*Correspondence: Francesc Moreso, ; Maria Jose Soler,
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5
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Toapanta N, Castañeda Z, Zúñiga J, León-Román J, Ramos N, Azancot M, Soler MJ. SARS CoV-2 seropositivity in haemodialysis patients. Nefrologia 2022; 42:733-736. [PMID: 36828704 PMCID: PMC9939397 DOI: 10.1016/j.nefroe.2021.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/25/2021] [Indexed: 06/18/2023] Open
Affiliation(s)
| | | | - José Zúñiga
- Hospital Universitario Valle de Hebrón, Barcelona, Spain
| | | | - Natalia Ramos
- Hospital Universitario Valle de Hebrón, Barcelona, Spain
| | - María Azancot
- Hospital Universitario Valle de Hebrón, Barcelona, Spain
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6
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Lopez-Martinez M, Torres I, Bermejo S, Moreso F, Garcia-Carro C, Vergara A, Ramos N, Perello M, Gabaldon A, Azancot MA, Bolufer M, Toapanta N, Bestard O, Agraz-Pamplona I, Soler MJ. Enteric Budesonide in Transplant and Native IgA Nephropathy: Real-World Clinical Practice. Transpl Int 2022; 35:10693. [PMID: 36311259 PMCID: PMC9613952 DOI: 10.3389/ti.2022.10693] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Marina Lopez-Martinez
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Irina Torres
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Sheila Bermejo
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Francesc Moreso
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain,*Correspondence: Francesc Moreso, ; Maria Jose Soler,
| | - Clara Garcia-Carro
- Department of Nephrology, San Carlos Clinical University Hospital, Madrid, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), San Carlos Clinical University Hospital, Madrid, Spain
| | - Ander Vergara
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Natalia Ramos
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Manel Perello
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Alejandra Gabaldon
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain,Department of Pathology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - M. Antonieta Azancot
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Monica Bolufer
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Nestor Toapanta
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Oriol Bestard
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Irene Agraz-Pamplona
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Maria Jose Soler
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain,*Correspondence: Francesc Moreso, ; Maria Jose Soler,
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7
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Miret Alomar E, Moreso F, Toapanta N, Lorente D, Triquell M, Pont T, Pérez-Hoyos S, Serón D, Morote J, Trilla E. Surgeon preimplantation macroscopic graft appraisal improves risk stratification of deceased kidney donors: a prospective study. Minerva Urol Nephrol 2022; 74:615-624. [PMID: 33887895 DOI: 10.23736/s2724-6051.21.04345-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Preimplantation scores assist with correct kidney graft allocation, but macroscopic graft features have never been evaluated in this scenario. METHODS We designed a graft appraisal questionnaire, assessed its reproducibility by comparing the senior and junior surgeon responses and evaluated which features can predict transplant outcomes in 202 patients transplanted from 144 donors at a tertiary center. We created new prediction models in combination with validated preimplantation scores. The primary outcome was graft loss or eGFR<30 mL/min/1.73 m2 at six months and secondary outcomes were delayed graft function, early graft loss and graft function at six months. RESULTS Interrater correlation was very good for adherent perinephric fat (kappa=0.91) and acceptable for cortical surface roughness (kappa=0.51) and cortical color (kappa=0.47). Adherent perirenal fat (Odds ratio=4.77; 95% CI: 2.10-10.85) and surface roughness (OR=2.11, 95% CI: 1.25-3.58) were independent predictors of the primary outcome, improving the kidney donor risk index efficacy model (AUC 0.71 vs. 0.82, P≤0.001), while cortical color and adherent fat improved the Irish risk model for delayed graft function (AUC 0.76 vs. 0.82, P=0.03). We created nomograms to visually assess the risk of both endpoints. CONCLUSIONS Kidney graft macroscopic appraisal is reproducible between surgeons and can improve the accuracy of clinical preimplantational prediction scores.
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Affiliation(s)
- Enric Miret Alomar
- Department of Urology and Kidney Transplantation, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain -
| | - Francesc Moreso
- Department of Nephrology and Kidney Transplantation, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Nestor Toapanta
- Department of Nephrology and Kidney Transplantation, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - David Lorente
- Department of Urology and Kidney Transplantation, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Marina Triquell
- Department of Urology and Kidney Transplantation, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Teresa Pont
- Transplant Coordination, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Santiago Pérez-Hoyos
- Unit of Statistics and Bioinformatics, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Daniel Serón
- Department of Nephrology and Kidney Transplantation, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan Morote
- Department of Urology and Kidney Transplantation, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Enrique Trilla
- Department of Urology and Kidney Transplantation, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
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8
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Vart P, Jager KJ, Arnol M, Duivenvoorden R, Franssen CFM, Groeneveld M, Hemmelder MH, Lepeytre F, Malfait T, Midtvedt K, Mitra S, Facundo C, Noordzij M, Reina CC, Safak S, Toapanta N, Hilbrands LB, Gansevoort RT. COVID-19 pandemic waves and mortality among patients on kidney replacement therapy. Kidney Int Rep 2022; 7:2091-2096. [PMID: 35757188 PMCID: PMC9213008 DOI: 10.1016/j.ekir.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/18/2022] [Accepted: 06/06/2022] [Indexed: 02/07/2023] Open
Affiliation(s)
- Priya Vart
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
| | - Kitty J Jager
- ERA Registry, Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Miha Arnol
- Department of Nephrology, University Medical Center Ljubljana; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Raphaël Duivenvoorden
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Casper F M Franssen
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Marc H Hemmelder
- Division on Nephrology, Department of Internal Medicine, Maastricht University Medical Centre; CARIM school for cardiovascular research, University Maastricht, Maastricht, Netherlands
| | - Fanny Lepeytre
- Claude Galien Hospital Ramsay santé, Quincy-sous-Sénart, France
| | | | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Olso, Norway
| | - Sandip Mitra
- Department of Renal Medicine, Manchester University Hospitals, Manchester Academy of Health Sciences Centre, University of Manchester, UK
| | | | - Marlies Noordzij
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Seda Safak
- Division on Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ron T Gansevoort
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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9
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Vart P, Jager KJ, Arnol M, Duivenvoorden R, Franssen CFM, Groeneveld M, Hemmelder MH, Lepeytre F, Malfait T, Midtvedt K, Mitra S, Facundo C, Noordzij M, Reina CC, Safak S, Toapanta N, Hilbrands LB, Gansevoort RT. MO495: A Comparative Study of Patient Mortality During First and Second Waves of Covid-19 Pandemic in Dialysis Patients and Kidney Transplant Recipients. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac071.026] [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
Patients on kidney replacement therapy (KRT) are at a particularly high risk of mortality from COVID-19. In this study, we investigated COVID-19 mortality in KRT patients in the first and second waves of the pandemic and potential reasons for any difference in mortality between the two waves.
METHOD
Data from the European Renal Association COVID-19 Database (ERACODA) of KRT patients who presented between 1 March 2020 and 28 February 2021 with COVID-19 were analyzed. The cut-off for dividing the first and second waves was set for 1 August 2020. The primary study outcome was 28-day mortality. Multivariable Cox proportional-hazards regression analysis was used to examine the relationship between the pandemic waves and mortality with follow-up time starting at the date of presentation. Dialysis patients and kidney transplant recipients were analyzed separately.
RESULTS
Among 3004 dialysis patients (1253 in the first and 1751 in the second wave), the 28-day mortality was 24.3% in the first wave and 19.6% in the second wave (P = .002). Compared with the first wave, in the second wave, identification of patients with limited to no symptoms was higher (14.3% versus 24.8%; P < .001), hospitalization was lower (71.3% versus 44.3%; P < .001), but in-hospital mortality was similar (30.4% versus 30.7%; P = .92) (Fig. 1). Crude hazard ratio (HR) for 28-day mortality in the second wave was 0.77 (95% CI: 0.66, 0.89). However, in a fully adjusted model, when correcting for differences in patient and disease characteristics, including the reason for COVID-19 screening and disease severity, the HR for mortality in the second wave was 0.93 [95% confidence interval (95% CI): 0.79–1.10]. When follow-up was chosen to start at the date of first symptoms to account for possible lead-time bias, crude HR for 28-day mortality in the second wave was 0.90 (95% CI: 0.75–1.07) and the fully adjusted HR was 0.98 (95% CI: 0.81–1.18). Among 1035 kidney transplant recipients (475 in the first and 560 in the second wave), results were essentially similar except that patients in the second wave were younger (55.6 years versus 58.2 years; P = .002), and crude HR for 28-day mortality from the date of first symptoms was 0.66 (95% CI: 0.47–0.93), whereas the fully adjusted HR was 1.02 (95% CI: 0.70–1.49).
CONCLUSION
Among patients on KRT with COVID-19, 28-day mortality rates were lower in the second wave compared with the first wave. However, a greater proportion of patients with minimal symptoms, lead-time bias in dialysis patients, and younger age in kidney transplant recipients possibly explain the lower mortality during the second wave. Any improvement in patient management during the second wave may not be the main reason for lower mortality.
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Affiliation(s)
- Priya Vart
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen, Netherlands
| | - Kitty J Jager
- ERA Registry, Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Miha Arnol
- Department of Nephrology, University Medical Center Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | | | - Casper F M Franssen
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Marc H Hemmelder
- Division on Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, CARIM school for cardiovascular research, University Maastricht, Maastricht, Netherlands
| | - Fanny Lepeytre
- Claude Galien Hospital Ramsay santé, Quincy-sous-Sénart, France
| | | | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Olso, Norway
| | - Sandip Mitra
- Department of Renal Medicine, Manchester University Hospitals, Manchester Academy of Health Sciences Centre, University of Manchester, UK
| | | | - Marlies Noordzij
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Seda Safak
- Division on Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ron T Gansevoort
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Bestard O, Jouve T, Castells L, Lopez M, Muñoz M, Crespo E, Toapanta N, Esperalba J, Campos‐Varela I, Pont T, Len O, Campins M, Moreso F. Reconciling short-term clinical and immunological outcomes of SARS-CoV-2 vaccination in solid organ transplant recipients. Am J Transplant 2022; 22:673-675. [PMID: 34554648 PMCID: PMC8653131 DOI: 10.1111/ajt.16855] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Oriol Bestard
- Kidney Transplant UnitNephrology DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de BarcelonaBarcelonaSpain,Laboratory of Nephrology and TransplantationVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Thomas Jouve
- Laboratory of Nephrology and TransplantationVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Lluís Castells
- Liver UnitVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)Instituto de Salud Carlos IIIMadridSpain
| | - Manuel Lopez
- Lung Transplant UnitVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Marina Muñoz
- Pediatric Transplant DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Elena Crespo
- Laboratory of Nephrology and TransplantationVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Nestor Toapanta
- Kidney Transplant UnitNephrology DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Juliana Esperalba
- Microbiology DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Isabel Campos‐Varela
- Liver UnitVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)Instituto de Salud Carlos IIIMadridSpain
| | - Teresa Pont
- Transplant Coordination DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Oscar Len
- Infectious Disease DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Magda Campins
- Deparment of Preventive Medicine and EpidemiologyVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Francesc Moreso
- Kidney Transplant UnitNephrology DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de BarcelonaBarcelonaSpain,Laboratory of Nephrology and TransplantationVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
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11
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León-Román J, Agraz I, Vergara A, Ramos N, Toapanta N, García-Carro C, Gabaldón A, Bury R, Bermejo S, Bestard O, Soler MJ. OUP accepted manuscript. Clin Kidney J 2022; 15:1698-1704. [PMID: 35999963 PMCID: PMC8992323 DOI: 10.1093/ckj/sfac079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Indexed: 11/25/2022] Open
Abstract
Novel coronavirus disease infection (coronavirus disease 2019, COVID-19) was declared a global pandemic in March 2020 and since then has become a major public health problem. The prevalence of COVID-19 infection and acute kidney injury (AKI) is variable depending on several factors such as race/ethnicity and severity of illness. The pathophysiology of renal involvement in COVID-19 infection is not entirely clear, but it could be in part explained by the viral tropism in the kidney parenchyma. AKI in COVID-19 infection can be either by direct invasion of the virus or as a consequence of immunologic response. Diverse studies have focused on the effect of COVID-19 on glomerulonephritis (GN) patients or the ‘novo’ GN; however, the effect of COVID-19 in acute tubulointerstitial nephritis (ATIN) has been scarcely studied. In this article, we present five cases with different spectrums of COVID-19 infection and ATIN that may suggest that recent diagnosis of ATIN is accompanied by a worse clinical prognosis in comparison with long-term diagnosed ATIN.
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Affiliation(s)
- Juan León-Román
- Vall d'Hebron University Hospital, Department of Nephrology, Barcelona, Spain
| | - Irene Agraz
- Vall d'Hebron University Hospital, Department of Nephrology, Barcelona, Spain
| | - Ander Vergara
- Vall d'Hebron University Hospital, Department of Nephrology, Barcelona, Spain
| | - Natalia Ramos
- Vall d'Hebron University Hospital, Department of Nephrology, Barcelona, Spain
| | - Nestor Toapanta
- Vall d'Hebron University Hospital, Department of Nephrology, Barcelona, Spain
| | - Clara García-Carro
- Clinico San Carlos University Hospital, Department of Nephrology, Madrid, Spain
| | - Alejandra Gabaldón
- Vall d'Hebron University Hospital, Department of Pathology, Barcelona, Spain
| | - Roxana Bury
- Vall d'Hebron University Hospital, Department of Nephrology, Barcelona, Spain
| | - Sheila Bermejo
- Vall d'Hebron University Hospital, Department of Nephrology, Barcelona, Spain
| | - Oriol Bestard
- Vall d'Hebron University Hospital, Department of Nephrology, Barcelona, Spain
- Nephrology Research Group, Vall d'Hebron Research Institute (VHIR), Nephrology
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12
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Quiroga B, Soler MJ, Ortiz A, Vaquera SM, Mantecón CJJ, Useche G, Márquez MGS, Carnerero M, Rodríguez MTJ, Ramos PM, Millán JCRS, Toapanta N, Gracia-Iguacel C, Cervera MCA, Lara NB, Leyva A, Rojas J, Gansevoort RT, de Sequera P. Safety and immediate humoral response of COVID-19 vaccines in chronic kidney disease patients: the SENCOVAC study. Nephrol Dial Transplant 2021; 37:1868-1878. [PMID: 34788858 PMCID: PMC8767866 DOI: 10.1093/ndt/gfab313] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background Chronic kidney disease (CKD) patients are at high-risk for severe Covid-19. The multicentric, observational and prospective SENCOVAC study aims to describe the humoral response and safety of SARS-CoV-2 vaccines in CKD patients. Safety and immediate humoral response results are reported here. Methods Four cohorts of patients were included: kidney transplant (KT) recipients, haemodialysis (HD), peritoneal dialysis (PD) and non-dialysis CKD patients from 50 Spanish centres. Adverse events after vaccine doses were recorded. At baseline and on day 28 after the last vaccine dose, anti-Spike antibodies were measured and compared between cohorts. Factors associated with development of anti-Spike antibodies were analyzed. Results 1746 participants were recruited: 1116 HD, 171 PD, 176 non-dialysis CKD patients and 283 KT recipients. Most patients (98%) received mRNA vaccines. At least one vaccine reaction developed after the first dose in 763 (53.5%) and after the second dose in 741 (54.5%) of patients. Anti-Spike antibodies were measured in the first 301 patients. At 28 days, 95% of patients had developed antibodies: 79% of KT, 98% of HD, 99% of PD and 100% of non-dialysis CKD patients (p<0.001). In a multivariate adjusted analysis, absence of an antibody response was independently associated to KT (OR 20.56, p = 0.001) and to BNT162b2 vaccine (OR 6.03, p = 0.023). Conclusion The rate of anti-Spike antibody development after vaccination in KT patients was low but in other CKD patients it approached 100%; suggesting that KT patients require persistent isolation measures and booster doses of a Covid-19 vaccine. Potential differences between Covid-19 vaccines should be explored in prospective controlled studies.
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Affiliation(s)
- Borja Quiroga
- Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - María José Soler
- Nephrology Department, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Alberto Ortiz
- IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Nestor Toapanta
- Nephrology Department, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Carolina Gracia-Iguacel
- IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | | | - Noelia Balibrea Lara
- Nephrology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Alba Leyva
- R&D Department, VIRCELL SL, Granada, Spain
| | - José Rojas
- R&D Department, VIRCELL SL, Granada, Spain
| | - Ron T Gansevoort
- Dept. Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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13
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Toapanta N, Bestard O, Soler MJ. SARS CoV-2 vaccination in patients receiving kidney replacement therapies: where are we now with the protective immune response? Nephrol Dial Transplant 2021; 36:1950-1954. [PMID: 34289072 PMCID: PMC8344521 DOI: 10.1093/ndt/gfab227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Indexed: 01/29/2023] Open
Affiliation(s)
- Nestor Toapanta
- Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Oriol Bestard
- Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - María José Soler
- Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, Barcelona, Spain
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14
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Román JL, García-Carro C, Agraz I, Toapanta N, Vergara A, Gabaldón A, Torres I, Bury R, Baldallo C, Serón D, Soler MJ. COVID-19 in CKD Patients: Lessons from 553 CKD Patients with Biopsy-Proven Kidney Disease. Kidney Blood Press Res 2021; 46:452-459. [PMID: 34098555 PMCID: PMC8247815 DOI: 10.1159/000515714] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/07/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Chronic kidney disease (CKD) patients infected with COVID-19 are at risk of serious complications such as hospitalization and death. The prognosis and lethality of COVID-19 infection in patients with established kidney disease has not been widely studied. Methods Data included patients who underwent kidney biopsy at the Vall d'Hebron Hospital between January 2013 and February 2020 with COVID-19 diagnosis during the period from March 1 to May 15, 2020. Results Thirty-nine (7%) patients were diagnosed with COVID-19 infection. Mean age was 63 ± 15 years and 48.7% were male. Hypertension was present in 79.5%, CKD without renal replacement therapy in 76.9%, and cardiovascular disease in 64.1%. Nasopharyngeal swab was performed in 26 patients; older (p = 0.01), hypertensive (p = 0.005), and immunosuppressed (p = 0.01) patients, those using RAS-blocking drugs (p = 0.04), and those with gastrointestinal symptoms (p = 0.02) were more likely to be tested for COVID-19. Twenty-two patients required hospitalization and 15.4% died. In bivariate analysis, mortality was associated with older age (p = 0.03), cardiovascular disease (p = 0.05), chronic obstructive pulmonary disease (p = 0.05), and low hemoglobin levels (p = 0.006). Adjusted Cox regression showed that low hemoglobin levels at admission had 1.81 greater risk of mortality. Conclusions Patients with COVID-19 infection and kidney disease confirmed by kidney biopsy presented a mortality of 15.4%. Swab test for COVID-19 was more likely to be performed in older, hypertensive, and immunosuppressed patients, those using RAS-blocking drugs, and those with gastrointestinal symptoms. Low hemoglobin is a risk factor for mortality.
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Affiliation(s)
- Juan León Román
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Clara García-Carro
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Irene Agraz
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Nestor Toapanta
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ander Vergara
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Nephrology Department, Nephrology Research Group, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandra Gabaldón
- Department of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Irina Torres
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Roxana Bury
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Cinthia Baldallo
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Daniel Serón
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Nephrology Department, Nephrology Research Group, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Instituto Carlos IIIFEDER, Red de Investigación Renal (REDINREN), Madrid, Spain
| | - María José Soler
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Nephrology Department, Nephrology Research Group, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Instituto Carlos IIIFEDER, Red de Investigación Renal (REDINREN), Madrid, Spain
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15
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Toapanta N, Castañeda Z, Zúñiga J, León-Román J, Ramos N, Azancot M, Soler MJ. SARS CoV-2 seropositivity in hemodialysis patients. Nefrologia 2021; 42:S0211-6995(21)00105-3. [PMID: 34217504 PMCID: PMC8156899 DOI: 10.1016/j.nefro.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - José Zúñiga
- Hospital Universitario Valle de Hebrón, Barcelona, España
| | | | - Natalia Ramos
- Hospital Universitario Valle de Hebrón, Barcelona, España
| | - María Azancot
- Hospital Universitario Valle de Hebrón, Barcelona, España
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16
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Favà A, Cucchiari D, Montero N, Toapanta N, Centellas FJ, Vila-Santandreu A, Coloma A, Meneghini M, Manonelles A, Sellarés J, Torres I, Gelpi R, Lorenzo I, Ventura-Aguiar P, Cofan F, Torregrosa JV, Perelló M, Facundo C, Seron D, Oppenheimer F, Bestard O, Cruzado JM, Moreso F, Melilli E. Clinical characteristics and risk factors for severe COVID-19 in hospitalized kidney transplant recipients: A multicentric cohort study. Am J Transplant 2020; 20:3030-3041. [PMID: 32777153 PMCID: PMC7436908 DOI: 10.1111/ajt.16246] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/16/2020] [Accepted: 07/24/2020] [Indexed: 01/25/2023]
Abstract
Kidney transplant recipients might be at higher risk for severe coronavirus disease 2019 (COVID-19). However, risk factors for relevant outcomes remain uncertain in this population. This is a multicentric kidney transplant cohort including 104 hospitalized patients between March 4 and April 17, 2020. Risk factors for death and acute respiratory distress syndrome (ARDS) were investigated, and clinical and laboratory data were analyzed. The mean age was 60 years. Forty-seven patients (54.8%) developed ARDS. Obesity was associated to ARDS development (OR 2.63; P = .04). Significant age differences were not found among patients developing and not developing ARDS (61.3 vs 57.8 years, P = .16). Seventy-six (73%) patients were discharged, and 28 (27%) died. Death was more common among the elderly (55 and 70.8 years, P < .001) and those with preexisting pulmonary disease (OR 2.89, P = .009). At admission, higher baseline lactate dehydrogenase (257 vs 358 IU/mL, P = .001) or ARDS conferred higher risk of death (HR 2.09, P = .044). In our cohort, ARDS was equally present among young and old kidney recipients. However, the elderly might be at higher risk of death, along with those showing higher baseline LDH at admission.
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Affiliation(s)
- Alexandre Favà
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - David Cucchiari
- Nephrology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Nuria Montero
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain,Correspondence Nuria Montero
| | - Nestor Toapanta
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | | | | | - Ana Coloma
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Maria Meneghini
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Anna Manonelles
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Joana Sellarés
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | - Irina Torres
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | - Rosana Gelpi
- Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | | | | | - Frederic Cofan
- Nephrology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Manel Perelló
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | - Carme Facundo
- Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Daniel Seron
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | | | - Oriol Bestard
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Josep M. Cruzado
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain,Josep M. Cruzado
| | - Francesc Moreso
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | - Edoardo Melilli
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
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