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Zeuschner P, Mihm J, Sester U, Stöckle M, Friedersdorff F, Budde K, Yakac A, Thomas C, Huber J, Putz J, Flegar L. Old for young kidney transplantation: a responsible option for our patients to reduce waiting time? World J Urol 2024; 42:85. [PMID: 38363345 PMCID: PMC10873431 DOI: 10.1007/s00345-024-04779-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/09/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE The Eurotransplant Senior program allocating grafts from donors ≥ 65 years to recipients aged ≥ 65 years has proven good results within the last 20 years. However, "old" grafts are also allocated to younger recipients < 65 years, and this outcome of "old for young" kidney transplantations (KT) still lacks detailed investigations. METHODS All "old for young" KT performed at four tertiary referral centers were retrospectively compared including a recent follow-up, stratifying for "old for young" (donor ≥ 65 years to recipient < 65 years) vs. "very old for young" KT (donor ≥ 70 years to recipient < 65 years). RESULTS Overall, 99 patients were included with 56 (56.6%) "old for young" and 43 (43.4%) "very old for young" KT. The median waiting time did not differ (60.7 vs. 45.8 months, respectively) at comparable living donation rates (57.1% vs. 44.2%) as well as intra- and postoperative results. At a median follow-up of 44 months (range 1; 133), the 3-year graft survival of 91% vs. 87% did not significantly vary. In subgroup analyses assessing living donation or donation after brain death (DBD) KT only, the graft survival was significantly longer for "old for young" KT within the living donation subgroup. In multivariate Cox regression analyses, the presence of panel-reactive antibodies was the only significant impact factor on graft survival (HR 8.32, p = 0.001). CONCLUSION This analysis clearly demonstrates the effectiveness of the "old for young" approach, enabling favorable perioperative results as well as comparable data of graft- and overall survival, while reducing waiting time for eligible patients.
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Affiliation(s)
- Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Street 100, 66421, Homburg/Saar, Germany.
| | - Janine Mihm
- Medical Department III: Renal and Hypertensive Diseases, Immunology and Dialysis, SHG Kliniken Völklingen, Richardstraße 5-9, 66333, Völklingen, Germany
| | - Urban Sester
- Medical Department III: Renal and Hypertensive Diseases, Immunology and Dialysis, SHG Kliniken Völklingen, Richardstraße 5-9, 66333, Völklingen, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Street 100, 66421, Homburg/Saar, Germany.
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
| | - Klemens Budde
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Abdulbaki Yakac
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Johannes Huber
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Juliane Putz
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Luka Flegar
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
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Bronder S, Mihm J, Urschel R, Klemis V, Schmidt T, Marx S, Abu-Omar A, Hielscher F, Guckelmus C, Widera M, Sester U, Sester M. Potent induction of humoral and cellular immunity after bivalent BA.4/5 mRNA vaccination in dialysis patients. NPJ Vaccines 2024; 9:25. [PMID: 38326340 PMCID: PMC10850212 DOI: 10.1038/s41541-024-00816-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024] Open
Abstract
Knowledge on immunogenicity of the bivalent Omicron BA.4/5 vaccine in dialysis patients and the effect of a previous infection is limited. Therefore, vaccine-induced humoral and cellular immunity was analyzed in dialysis patients and immunocompetent controls with and without prior infection. In an observational study, 33 dialysis patients and 58 controls matched for age, sex and prior infection status were recruited. Specific IgG, neutralizing antibody activity and cellular immunity towards the spike-antigen from parental SARS-CoV-2 and Omicron-subvariants BA.1, BA.2 and BA.4/5 were analyzed before and 13-18 days after vaccination. The bivalent vaccine led to a significant induction of IgG, neutralizing titers, and specific CD4+ and CD8+ T-cell levels. Neutralizing activity towards the parental strain was higher than towards the Omicron-subvariants, whereas specific T-cell levels towards parental spike and Omicron-subvariants did not differ indicating substantial cross-reactivity. Dialysis patients with prior infection had significantly higher spike-specific CD4+ T-cell levels with lower CTLA-4 expression compared to infection-naive patients. When compared to controls, no differences were observed between infection-naive individuals. Among convalescent individuals, CD4+ T-cell levels were higher in patients and neutralizing antibodies were higher in controls. Vaccination was overall well tolerated in both dialysis patients and controls with significantly less adverse events among patients. In conclusion, our study did not provide any evidence for impaired immunogenicity of the bivalent Omicron BA.4/5 vaccine in dialysis patients. Unlike in controls, previous infection of patients was even associated with higher levels of spike-specific CD4+ T cells, which may reflect prolonged encounter with antigen during infection.
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Affiliation(s)
- Saskia Bronder
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | | | - Rebecca Urschel
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Verena Klemis
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Tina Schmidt
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Stefanie Marx
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Amina Abu-Omar
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Franziska Hielscher
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Candida Guckelmus
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Marek Widera
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | | | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany.
- Center for Gender-specific Biology and Medicine (CGBM), Saarland University, Homburg, Germany.
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3
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Klemis V, Schmidt T, Schub D, Mihm J, Marx S, Abu-Omar A, Ziegler L, Hielscher F, Guckelmus C, Urschel R, Wagenpfeil S, Schneitler S, Becker SL, Gärtner BC, Sester U, Sester M. Comparative immunogenicity and reactogenicity of heterologous ChAdOx1-nCoV-19-priming and BNT162b2 or mRNA-1273-boosting with homologous COVID-19 vaccine regimens. Nat Commun 2022; 13:4710. [PMID: 35953492 PMCID: PMC9366133 DOI: 10.1038/s41467-022-32321-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 07/25/2022] [Indexed: 12/30/2022] Open
Abstract
Comparative analyses of the immunogenicity and reactogenicity of homologous and heterologous SARS-CoV-2 vaccine-regimens will inform optimized vaccine strategies. Here we analyze the humoral and cellular immune response following heterologous and homologous vaccination strategies in a convenience cohort of 331 healthy individuals. All regimens induce immunity to the vaccine antigen. Immunity after vaccination with ChAdOx1-nCoV-19 followed by either BNT162b2 (n = 66) or mRNA-1273 (n = 101) is equivalent to or more pronounced than homologous mRNA-regimens (n = 43 BNT162b2, n = 59 mRNA-1273) or homologous ChAdOx1-nCoV-19 vaccination (n = 62). We note highest levels of spike-specific CD8 T-cells following both heterologous regimens. Among mRNA-containing combinations, spike-specific CD4 T-cell levels in regimens including mRNA-1273 are higher than respective combinations with BNT162b2. Polyfunctional T-cell levels are highest in regimens based on ChAdOx1-nCoV-19-priming. All five regimens are well tolerated with most pronounced reactogenicity upon ChAdOx1-nCoV-19-priming, and ChAdOx1-nCoV-19/mRNA-1273-boosting. In conclusion, we present comparative analyses of immunogenicity and reactogenicity for heterologous vector/mRNA-boosting and homologous mRNA-regimens. Multiple formulations and technologies for vaccinating against SARS-CoV-2 exist but how the use of these in homologous or heterologous format impacts immunogenicity is far from clear. Here the authors compare a range of heterologous and homologous SARS-CoV-2 vaccination strategies and assess the induced humoral and cellular immune response.
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Affiliation(s)
- Verena Klemis
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Tina Schmidt
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - David Schub
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Janine Mihm
- Department of Internal Medicine IV, Saarland University, Homburg, Germany.,SHG Kliniken, Völklingen, Germany
| | - Stefanie Marx
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Amina Abu-Omar
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Laura Ziegler
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Franziska Hielscher
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Candida Guckelmus
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Rebecca Urschel
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Statistics, Epidemiology and Medical Informatics, Saarland University, Campus Homburg/Saar, Homburg, Germany
| | - Sophie Schneitler
- Institute of Medical Microbiology and Hygiene, Saarland University, 66421, Homburg, Germany
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, 66421, Homburg, Germany
| | - Barbara C Gärtner
- Institute of Medical Microbiology and Hygiene, Saarland University, 66421, Homburg, Germany
| | - Urban Sester
- Department of Internal Medicine IV, Saarland University, Homburg, Germany.,SHG Kliniken, Völklingen, Germany
| | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany.
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Schmidt T, Klemis V, Schub D, Schneitler S, Reichert MC, Wilkens H, Sester U, Sester M, Mihm J. Cellular immunity predominates over humoral immunity after homologous and heterologous mRNA and vector-based COVID-19 vaccine regimens in solid organ transplant recipients. Am J Transplant 2021; 21:3990-4002. [PMID: 34453872 PMCID: PMC8652989 DOI: 10.1111/ajt.16818] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [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: 05/07/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 01/25/2023]
Abstract
Knowledge on the immunogenicity of vector-based and mRNA-vaccines in solid organ transplant recipients is limited. Therefore, SARS-CoV-2-specific T cells and antibodies were analyzed in 40 transplant recipients and 70 controls after homologous or heterologous vaccine-regimens. Plasmablasts and SARS-CoV-2-specific CD4 and CD8 T cells were quantified using flow cytometry. Specific antibodies were analyzed by ELISA and neutralization assay. The two vaccine types differed after the first vaccination, as IgG and neutralizing activity were more pronounced after mRNA priming (p = .0001 each), whereas CD4 and CD8 T cell levels were higher after vector priming (p = .009; p = .0001). All regimens were well tolerated, and SARS-CoV-2-specific antibodies and/or T cells after second vaccination were induced in 100% of controls and 70.6% of transplant recipients. Although antibody and T cell levels were lower in patients, heterologous vaccination led to the most pronounced induction of antibodies and CD4 T cells. Plasmablast numbers were significantly higher in controls and correlated with SARS-CoV-2-specific IgG- and T cell levels. While antibodies were only detected in 35.3% of patients, cellular immunity was more frequently found (64.7%) indicating that assessment of antibodies is insufficient to identify COVID-19-vaccine responders. In conclusion, heterologous vaccination seems promising in transplant recipients, and combined analysis of humoral and cellular immunity improves the identification of responders among immunocompromised individuals.
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Affiliation(s)
- Tina Schmidt
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Verena Klemis
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - David Schub
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Sophie Schneitler
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | | | - Heinrike Wilkens
- Department of Internal Medicine V, Saarland University, Homburg, Germany
| | - Urban Sester
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
| | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany,Correspondence Martina Sester, Department of Transplant and Infection Immunology, Saarland University, 66421 Homburg, Germany.
| | - Janine Mihm
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
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Schmidt T, Klemis V, Schub D, Mihm J, Hielscher F, Marx S, Abu-Omar A, Ziegler L, Guckelmus C, Urschel R, Schneitler S, Becker SL, Gärtner BC, Sester U, Sester M. Immunogenicity and reactogenicity of heterologous ChAdOx1 nCoV-19/mRNA vaccination. Nat Med 2021; 27:1530-1535. [PMID: 34312554 PMCID: PMC8440177 DOI: 10.1038/s41591-021-01464-w] [Citation(s) in RCA: 210] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
Heterologous priming with the ChAdOx1 nCoV-19 vector vaccine followed by boosting with a messenger RNA vaccine (BNT162b2 or mRNA-1273) is currently recommended in Germany, although data on immunogenicity and reactogenicity are not available. In this observational study we show that, in healthy adult individuals (n = 96), the heterologous vaccine regimen induced spike-specific IgG, neutralizing antibodies and spike-specific CD4 T cells, the levels of which which were significantly higher than after homologous vector vaccine boost (n = 55) and higher or comparable in magnitude to homologous mRNA vaccine regimens (n = 62). Moreover, spike-specific CD8 T cell levels after heterologous vaccination were significantly higher than after both homologous regimens. Spike-specific T cells were predominantly polyfunctional with largely overlapping cytokine-producing phenotypes in all three regimens. Recipients of both the homologous vector regimen and the heterologous vector/mRNA combination reported greater reactogenicity following the priming vector vaccination, whereas heterologous boosting was well tolerated and comparable to homologous mRNA boosting. Taken together, heterologous vector/mRNA boosting induces strong humoral and cellular immune responses with acceptable reactogenicity profiles. In healthy adults, booster vaccination with an mRNA vaccine, irrespective of the vaccine used for the first dose, was well tolerated and elicited higher levels of spike-specific antibodies and spike-specific T cells than booster vaccination with ChAdOx1 nCov-19.
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Affiliation(s)
- Tina Schmidt
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Verena Klemis
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - David Schub
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Janine Mihm
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
| | - Franziska Hielscher
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Stefanie Marx
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Amina Abu-Omar
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Laura Ziegler
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Candida Guckelmus
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Rebecca Urschel
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Sophie Schneitler
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Barbara C Gärtner
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Urban Sester
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
| | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany.
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Schub D, Klemis V, Schneitler S, Mihm J, Lepper PM, Wilkens H, Bals R, Eichler H, Gärtner BC, Becker SL, Sester U, Sester M, Schmidt T. High levels of SARS-CoV-2-specific T cells with restricted functionality in severe courses of COVID-19. JCI Insight 2020; 5:142167. [PMID: 32937615 PMCID: PMC7605520 DOI: 10.1172/jci.insight.142167] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/16/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) differ in the severity of disease. We hypothesized that characteristics of SARS-CoV-2–specific immunity correlate with disease severity. METHODS In this study, SARS-CoV-2–specific T cells and antibodies were characterized in uninfected controls and patients with different coronavirus disease 2019 (COVID-19) disease severity. SARS-CoV-2–specific T cells were flow cytometrically quantified after stimulation with SARS-CoV-2 peptide pools and analyzed for expression of cytokines (IFN-γ, IL-2, and TNF-α) and markers for activation, proliferation, and functional anergy. SARS-CoV-2–specific IgG and IgA antibodies were quantified using ELISA. Moreover, global characteristics of lymphocyte subpopulations were compared between patient groups and uninfected controls. RESULTS Despite severe lymphopenia affecting all major lymphocyte subpopulations, patients with severe disease mounted significantly higher levels of SARS-CoV-2–specific T cells as compared with convalescent individuals. SARS-CoV-2–specific CD4+ T cells dominated over CD8+ T cells and closely correlated with the number of plasmablasts and SARS-CoV-2–specific IgA and IgG levels. Unlike in convalescent patients, SARS-CoV-2–specific T cells in patients with severe disease showed marked alterations in phenotypical and functional properties, which also extended to CD4+ and CD8+ T cells in general. CONCLUSION Given the strong induction of specific immunity to control viral replication in patients with severe disease, the functionally altered characteristics may result from the need for contraction of specific and general immunity to counteract excessive immunopathology in the lung. FUNDING The study was supported by institutional funds to MS and in part by grants of Saarland University, the State of Saarland, and the Rolf M. Schwiete Stiftung. COVID-19 patients with severe disease have higher levels of SARS-CoV-2 specific T-cells as compared to convalescent individuals.
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Affiliation(s)
- David Schub
- Department of Transplant and Infection Immunology
| | | | | | | | | | | | | | - Hermann Eichler
- Institute of Clinical Hemostaseology and Transfusion Medicine, Saarland University, Homburg, Germany
| | | | | | | | | | - Tina Schmidt
- Department of Transplant and Infection Immunology
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7
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Zeuschner P, Sester U, Stöckle M, Saar M, Zompolas I, El-Bandar N, Liefeldt L, Budde K, Öllinger R, Ritschl P, Schlomm T, Mihm J, Friedersdorff F. Should We Perform Old-for-Old Kidney Transplantation during the COVID-19 Pandemic? The Risk for Post-Operative Intensive Stay. J Clin Med 2020; 9:jcm9061835. [PMID: 32545566 PMCID: PMC7356807 DOI: 10.3390/jcm9061835] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022] Open
Abstract
Health care systems worldwide have been facing major challenges since the outbreak of the SARS-CoV-2 pandemic. Kidney transplantation (KT) has been tremendously affected due to limited personal protective equipment (PPE) and intensive care unit (ICU) capacities. To provide valid information on risk factors for ICU admission in a high-risk cohort of old kidney recipients from old donors in the Eurotransplant Senior Program (ESP), we retrospectively conducted a bi-centric analysis. Overall, 17 (16.2%) patients out of 105 KTs were admitted to the ICU. They had a lower BMI, and both coronary artery disease (CAD) and hypertensive nephropathy were more frequent. A risk model combining BMI, CAD and hypertensive nephropathy gained a sensitivity of 94.1% and a negative predictive value of 97.8%, rendering it a valuable search test, but with low specificity (51.1%). ICU admission also proved to be an excellent parameter identifying patients at risk for short patient and graft survivals. Patients admitted to the ICU had shorter patient (1-year 57% vs. 90%) and graft (5-year 49% vs. 77%) survival. To conclude, potential kidney recipients with a low BMI, CAD and hypertensive nephropathy should only be transplanted in the ESP in times of SARS-CoV-2 pandemic if the local health situation can provide sufficient ICU capacities.
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Affiliation(s)
- Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Street 100, 66421 Homburg/Saar, Germany; (P.Z.); (M.S.); (M.S.)
| | - Urban Sester
- Department of Nephrology and Hypertension, Internal Medicine IV, Saarland University, Kirrberger Street 100, 66421 Homburg/Saar, Germany; (U.S.); (J.M.)
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Street 100, 66421 Homburg/Saar, Germany; (P.Z.); (M.S.); (M.S.)
| | - Matthias Saar
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Street 100, 66421 Homburg/Saar, Germany; (P.Z.); (M.S.); (M.S.)
| | - Ilias Zompolas
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (I.Z.); (N.E.-B.); (T.S.)
| | - Nasrin El-Bandar
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (I.Z.); (N.E.-B.); (T.S.)
| | - Lutz Liefeldt
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (L.L.); (K.B.)
| | - Klemens Budde
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (L.L.); (K.B.)
| | - Robert Öllinger
- Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum CCM/CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (R.Ö.); (P.R.)
| | - Paul Ritschl
- Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum CCM/CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (R.Ö.); (P.R.)
| | - Thorsten Schlomm
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (I.Z.); (N.E.-B.); (T.S.)
| | - Janine Mihm
- Department of Nephrology and Hypertension, Internal Medicine IV, Saarland University, Kirrberger Street 100, 66421 Homburg/Saar, Germany; (U.S.); (J.M.)
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (I.Z.); (N.E.-B.); (T.S.)
- Correspondence:
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8
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Marx S, Adam C, Mihm J, Weyrich M, Sester U, Sester M. A Polyclonal Immune Function Assay Allows Dose-Dependent Characterization of Immunosuppressive Drug Effects but Has Limited Clinical Utility for Predicting Infection on an Individual Basis. Front Immunol 2020; 11:916. [PMID: 32499781 PMCID: PMC7243819 DOI: 10.3389/fimmu.2020.00916] [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: 01/06/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022] Open
Abstract
Dosage of immunosuppressive drugs after transplantation critically determines rejection and infection episodes. In this study, a global immune function assay was characterized among controls, dialysis-patients, and transplant-recipients to evaluate its utility for pharmacodynamic monitoring of immunosuppressive drugs and for predicting infections. Whole-blood samples were stimulated with anti-CD3/toll-like-receptor (TLR7/8)-agonist in the presence or absence of drugs and IFN-γ secretion was measured by ELISA. Additional stimulation-induced cytokines were characterized among T-, B-, and NK-cells using flow-cytometry. Cytokine-secretion was dominated by IFN-γ, and mainly observed in CD4, CD8, and NK-cells. Intra-assay variability was low (CV = 10.4 ± 6.2%), whereas variability over time was high, even in the absence of clinical events (CV = 65.0 ± 35.7%). Cyclosporine A, tacrolimus and steroids dose-dependently inhibited IFN-γ secretion, and reactivity was further reduced when calcineurin inhibitors were combined with steroids. Moreover, IFN-γ levels significantly differed between controls, dialysis-patients, and transplant-recipients, with lowest IFN-γ levels early after transplantation (p < 0.001). However, a single test had limited ability to predict infectious episodes. In conclusion, the assay may have potential for basic pharmacodynamic characterization of immunosuppressive drugs and their combinations, and for assessing loss of global immunocompetence after transplantation, but its application to guide drug-dosing and to predict infectious on an individual basis is limited.
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Affiliation(s)
- Stefanie Marx
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Claudia Adam
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
| | - Janine Mihm
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
| | - Michael Weyrich
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
| | - Urban Sester
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
| | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
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9
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Fischer M, Leyking S, Schäfer M, Elsäßer J, Janssen M, Mihm J, van Bentum K, Fliser D, Sester M, Sester U. Donor-specific alloreactive T cells can be quantified from whole blood, and may predict cellular rejection after renal transplantation. Eur J Immunol 2017; 47:1220-1231. [PMID: 28426152 DOI: 10.1002/eji.201646826] [Citation(s) in RCA: 7] [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: 11/22/2016] [Revised: 03/06/2017] [Accepted: 04/18/2017] [Indexed: 11/07/2022]
Abstract
Preformed cellular alloreactivity can exist prior to transplantation and may contribute to rejection. Here, we used a rapid flow-cytometric whole-blood assay to characterize the extent of alloreactive T cells among 1491 stimulatory reactions from 61 renal transplant candidates and 75 controls. The role of preformed donor-specific alloreactive T cells in cellular rejection was prospectively analyzed in 21 renal transplant recipients. Alloreactive CD8+ T cells were more frequent than respective CD4+ T cells, and these levels were stable over time. CD8+ T cells were effector-memory T cells largely negative for expression of CD27, CD62L, and CCR7, and were susceptible to steroid and calcineurin inhibitor inhibition. Alloreactivity was more frequent in samples with higher number of HLA mismatches. Moreover, the percentage of individuals with alloreactive T cells was higher in transplant candidates than in controls. Among transplant candidates, 5/61 exhibited alloreactive CD8+ T cells against most stimulators, 23/61 toward a limited number of stimulators, and 33/61 did not show any alloreactivity. Among 21 renal transplant recipients followed prospectively, one had donor-specific preformed T-cell alloreactivity. She was the only patient who developed cellular rejection posttransplantation. In conclusion, donor-specific alloreactive T cells may be rapidly quantified from whole blood, and may predict cellular rejection after transplantation.
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Affiliation(s)
- Michaela Fischer
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Sarah Leyking
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
| | - Marco Schäfer
- HLA-Laboratory, Stefan-Morsch-Stiftung, Birkenfeld, Germany
| | - Julia Elsäßer
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Martin Janssen
- Department of Urology and Paediatric Urology, Saarland University, Homburg, Germany
| | - Janine Mihm
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
| | - Kai van Bentum
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany.,Department of Internal Medicine IV, Saarland University, Homburg, Germany
| | - Danilo Fliser
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
| | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Urban Sester
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
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10
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Mihm J, Leyking S, Dirks J, Smola S, Fliser D, Sester U, Sester M, Wilkens H, Rissland J. Immune-based guidance of foscarnet treatment duration in a transplant recipient with ganciclovir-resistant cytomegalovirus infection. J Clin Virol 2016; 82:5-8. [DOI: 10.1016/j.jcv.2016.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 05/09/2016] [Accepted: 06/22/2016] [Indexed: 01/24/2023]
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11
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Leyking S, Wolf M, Mihm J, Schaefer M, Bohle RM, Fliser D, Sester M, Sester U. Alloreactive T Cells to Identify Risk HLA Alleles for Retransplantation After Acute Accelerated Steroid-Resistant Rejection. Transplant Proc 2016; 47:2425-32. [PMID: 26518945 DOI: 10.1016/j.transproceed.2015.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/16/2015] [Accepted: 09/02/2015] [Indexed: 02/05/2023]
Abstract
The risk of rejection by cellular alloreactivity to the transplant donor is not routinely assessed. Here we analyzed alloreactive T cells in kidney transplant recipients and report how their detection may have helped to prevent rejection of a second kidney graft in a patient with a history of acute accelerated steroid-resistant nonhumoral rejection. Alloreactive CD4 and CD8 T cells were quantified using a flow-cytometric mixed lymphocyte reaction assay based on interferon-γ induction. A group of 16 nonrejecting transplant recipients did not show any alloreactive T-cell immunity to their respective donors, whereas alloreactivity to third-party controls was detectable. In the patient with rejection, HLA-specific antibodies were not detectable before and shortly after rejection, but after transplantation the patient showed exceptionally high frequencies of alloreactive T cells against 2 of 11 HLA-typed controls (0.604% and 0.791% alloreactive CD4 T cells and 0.792% and 0.978% alloreactive CD8 T cells) who shared HLA alleles (HLA-A*24, -B*44, -C*02, -DQB1*5) with the kidney donor. These HLA alleles were subsequently excluded for allocation of a second graft. No alloreactive T cells were observed toward the second kidney donor, and this transplantation was performed successfully. Thus, shared HLA alleles between the donor and third-party controls may suggest that alloreactive T cells had contributed to rejection of the first graft. The rejecting patient highlights that determination of cellular alloreactivity before transplantation may be applied to identify unacceptable mismatches and to reduce the risk for acute cellular rejection episodes.
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Affiliation(s)
- S Leyking
- Department of Internal Medicine IV, Saarland University, Homburg, Germany; Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - M Wolf
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - J Mihm
- Department of Internal Medicine IV, Saarland University, Homburg, Germany; Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - M Schaefer
- HLA-Laboratory, Stefan-Morsch-Stiftung, Birkenfeld, Germany
| | - R M Bohle
- Department of Pathology, Saarland University, Homburg, Germany
| | - D Fliser
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
| | - M Sester
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany.
| | - U Sester
- Department of Internal Medicine IV, Saarland University, Homburg, Germany
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12
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Poelma PL, Andrews WH, Wilson CR, Coles CM, Edwards AW, Hayden MA, Haymond RE, Heagy J, Kallander K, Lappin D, Latt TG, McDonald RL, McKee CR, Mihm J, Palmieri MJ, Quinones L, Richter SG, Roderick CN, Sado PN, Sellers RL, Singleton E, Smith M, Tardio JL, Wagner DE, White CH, Williams MP. Pre-enrichment Broths for Recovery of Salmonella from Milk Chocolate and Edible Casein: Collaborative Study. J AOAC Int 1981. [DOI: 10.1093/jaoac/64.4.893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
A collaborative study was conducted to compare the relative efficiency of nonfat dry milk with brilliant green dye (NFDM-BG) and buffered peptone water (BPVV) as pre-enrichment broths for recovery of Salmonella from milk chocolate. Lactose broth and modified lactose broth with added 1% NaHCO3 and brilliant green dye were compared as pre-enrichment broths for recovery of Salmonella from edible casein. Two sets of 8 samples each of milk chocolate, containing initial levels of Salmonella ranging from <0.03 to 43 organisms/g, were examined by 13 collaborators. Of 104 determinations, 102 (98.1%) and 100(96.2%) using NFDM-BG and BPW, respectively, were in agreement with sample results of the control laboratory. Two sets of 7 samples each of edible casein, containing initial levels of Salmonella ranging from <0.03 to 93 organisms/g, were also examined by the 13 collaborators. Of 91 determinations, 87 (95.6%) and 88 (96.7%) using lactose broth and modified lactose broth, respectively, were in agreement with sample results of the control laboratory. For recovery of Salmonella, therefore, NFDM-BG pre-enrichment is recommended for milk chocolate, and lactose broth is recommended for casein. The proposed revision of official final action method 46.054-46.067 has been adopted official first action
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Affiliation(s)
- Paul L Poelma
- Food and Drug Administration, Division of Microbiology, Washington, DC 20204
| | - Wallace H Andrews
- Food and Drug Administration, Division of Microbiology, Washington, DC 20204
| | - Clyde R Wilson
- Food and Drug Administration, Division of Microbiology, Washington, DC 20204
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