1
|
Eid R, Scemla A, Giral M, Arzouk N, Bertrand D, Peraldi MN, Mesnard L, Longuet H, Maanaoui M, Desbuissons G, Lefevre E, Snanoudj R. Use of a Belatacept-based Immunosuppression for Kidney Transplantation From Donors After Circulatory Death: A Paired Kidney Analysis. Transplant Direct 2024; 10:e1615. [PMID: 38617465 PMCID: PMC11013701 DOI: 10.1097/txd.0000000000001615] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/10/2024] [Accepted: 01/21/2024] [Indexed: 04/16/2024] Open
Abstract
Background Efficacy and safety of belatacept have not been specifically reported for kidney transplantations from donors after circulatory death. Methods In this retrospective multicenter paired kidney study, we compared the outcome of kidney transplantations with a belatacept-based to a calcineurin inhibitor (CNI)-based immunosuppression. We included all kidney transplant recipients from donors after uncontrolled or controlled circulatory death performed in our center between February 2015 and October 2020 and treated with belatacept (n = 31). The control group included the recipients of the contralateral kidney that were treated with CNI in 8 other centers (tacrolimus n = 29, cyclosporine n = 2). Results There was no difference in the rate of delayed graft function. A higher incidence of biopsy-proven rejections was noted in the belatacept group (24 versus 6 episodes). Estimated glomerular filtration rate (eGFR) was significantly higher in the belatacept group at 3-, 12-, and 36-mo posttransplant, but the slope of eGFR was similar in the 2 groups. During a mean follow-up of 4.1 y, 12 patients discontinued belatacept and 2 patients were switched from CNI to belatacept. For patients who remained on belatacept, eGFR mean value and slope were significantly higher during the whole follow-up. At 5 y, eGFR was 80.7 ± 18.5 with belatacept versus 56.3 ± 22.0 mL/min/1.73 m2 with CNI (P = 0.003). No significant difference in graft and patient survival was observed. Conclusions The use of belatacept for kidney transplants from either uncontrolled or controlled donors after circulatory death resulted in a better medium-term renal function for patients remaining on belatacept despite similar rates of delayed graft function and higher rates of cellular rejection.
Collapse
Affiliation(s)
- Rita Eid
- Department of Nephrology and Transplantation, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
| | - Anne Scemla
- Department of Nephrology and Transplantation, Necker University Hospital for Sick Children, AP-HP, Paris, France
| | - Magali Giral
- Department of Nephrology and Transplantation, Nantes University Hospital Centre, Nantes, France
| | - Nadia Arzouk
- Department of Nephrology and Transplantation, Pitié Salpêtrière University Hospital, AP-HP, Paris, France
| | - Dominique Bertrand
- Department of Nephrology and Transplantation, Rouen University Hospital Centre, Rouen, France
| | - Marie-Noëlle Peraldi
- Department of Nephrology and Transplantation, Saint-Louis Hospital, AP-HP, Paris, France
| | - Laurent Mesnard
- Department of Nephrology and Transplantation, Tenon Hospital, AP-HP, Paris, France
| | - Helene Longuet
- Department of Nephrology and Transplantation, Tours University Hospital Centre, Tours, France
| | - Mehdi Maanaoui
- Department of Nephrology and Transplantation, Lille University Hospital Centre, Lille, France
| | - Geoffroy Desbuissons
- Department of Nephrology and Transplantation, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
| | - Edouard Lefevre
- Department of Nephrology and Transplantation, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
| | - Renaud Snanoudj
- Department of Nephrology and Transplantation, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
| |
Collapse
|
2
|
Giral M, Grimbert P, Morin B, Bouvier N, Buchler M, Dantal J, Garrigue V, Bertrand D, Kamar N, Malvezzi P, Moreau K, Athea Y, Le Meur Y. Impact of Switching From Immediate- or Prolonged-Release to Once-Daily Extended-Release Tacrolimus (LCPT) on Tremor in Stable Kidney Transplant Recipients: The Observational ELIT Study. Transpl Int 2024; 37:11571. [PMID: 38694490 PMCID: PMC11061389 DOI: 10.3389/ti.2024.11571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/31/2024] [Indexed: 05/04/2024]
Abstract
Once-daily extended-release tacrolimus (LCPT) exhibits increased bioavailability versus immediate-release (IR-TAC) and prolonged release (PR-TAC) tacrolimus. Improvements in tremor were previously reported in a limited number of kidney transplant patients who switched to LCPT. We conducted a non-interventional, non-randomized, uncontrolled, longitudinal, prospective, multicenter study to assess the impact of switching to LCPT on tremor and quality of life (QoL) in a larger population of stable kidney transplant patients. The primary endpoint was change in The Essential Tremor Rating Assessment Scale (TETRAS) score; secondary endpoints included 12-item Short Form Survey (SF-12) scores, tacrolimus trough concentrations, neurologic symptoms, and safety assessments. Subgroup analyses were conducted to assess change in TETRAS score and tacrolimus trough concentration/dose (C0/D) ratio by prior tacrolimus formulation and tacrolimus metabolizer status. Among 221 patients, the mean decrease of TETRAS score after switch to LCPT was statistically significant (p < 0.0001 vs. baseline). There was no statistically significant difference in change in TETRAS score after switch to LCPT between patients who had received IR-TAC and those who had received PR-TAC before switch, or between fast and slow metabolizers of tacrolimus. The overall increase of C0/D ratio post-switch to LCPT was statistically significant (p < 0.0001) and from baseline to either M1 or M3 (both p < 0.0001) in the mITT population and in all subgroups. In the fast metabolizers group, the C0/D ratio crossed over the threshold of 1.05 ng/mL/mg after the switch to LCPT. Other neurologic symptoms tended to improve, and the SF-12 mental component summary score improved significantly. No new safety concerns were evident. In this observational study, all patients had a significant improvement of tremor, QoL and C0/D ratio post-switch to LCPT irrespective of the previous tacrolimus formulation administered (IR-TAC or PR-TAC) and irrespective from their metabolism status (fast or slow metabolizers).
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Nassim Kamar
- CHU Toulouse, Université Paul Sabatier Toulouse III, Toulouse, France
| | | | | | | | | |
Collapse
|
3
|
Masset C, Garandeau C, Ville S, Giral M, Houzet A, Branchereau J, Chelghaf I, Mesnard B, Blancho G, Dantal J, Cantarovich D. Belatacept in Pancreas Transplantation: Promising Insights From a Cohort Series. Transpl Int 2024; 37:12778. [PMID: 38689693 PMCID: PMC11058835 DOI: 10.3389/ti.2024.12778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/29/2024] [Indexed: 05/02/2024]
Affiliation(s)
- Christophe Masset
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, Unité Mixte de Recherche (UMR), Nantes, France
| | - Claire Garandeau
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Simon Ville
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, Unité Mixte de Recherche (UMR), Nantes, France
| | - Magali Giral
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, Unité Mixte de Recherche (UMR), Nantes, France
| | - Aurélie Houzet
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Julien Branchereau
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, Unité Mixte de Recherche (UMR), Nantes, France
| | - Ismaël Chelghaf
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Benoit Mesnard
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, Unité Mixte de Recherche (UMR), Nantes, France
| | - Gilles Blancho
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, Unité Mixte de Recherche (UMR), Nantes, France
| | - Jacques Dantal
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, Unité Mixte de Recherche (UMR), Nantes, France
| | - Diego Cantarovich
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| |
Collapse
|
4
|
Bézie S, Sérazin C, Autrusseau E, Vimond N, Giral M, Anegon I, Guillonneau C. Renal graft function in transplanted patients correlates with CD45RC T cell phenotypic signature. PLoS One 2024; 19:e0300032. [PMID: 38512889 PMCID: PMC10956768 DOI: 10.1371/journal.pone.0300032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Biomarkers that could predict the evolution of the graft in transplanted patients and that could allow to adapt the care of the patients would be an invaluable tool. Additionally, certain biomarkers can be target of treatments and help to stratify patients. Potential effective biomarkers have been identified but still need to be confirmed. CD45RC, one of the splicing variants of the CD45 molecule, a tyrosine phosphatase that is critical in negatively or positively regulating the TCR and the BCR signaling, is one marker already described. The frequency of CD8+ T cells expressing high levels of CD45RC before transplantation is increased in patients with an increased risk of acute rejection. However, single biomarkers have limited predictive reliability and the correlation of the expression levels of CD45RC with other cell markers was not reported. In this study, we performed a fluorescent-based high dimensional immunophenotyping of T cells on a cohort of 69 kidney transplant patients either with stable graft function or having experienced acute transplant rejection during the first year after transplantation or at the time of rejection. We identified combinations of markers and cell subsets associated with activation/inflammation or Tregs/tolerance (HLA-DR, PD-1, IFNγ, CD28) as significant biomarkers associated to transplant outcome, and showed the importance of cell segregation based on the CD45RC marker to identify the signature of a stable graft function. Our study highlights potential reliable biomarkers in transplantation to predict and/or monitor easily graft-directed immune responses and adapt immunosuppression treatments to mitigate adverse effects.
Collapse
Affiliation(s)
- Séverine Bézie
- Center for Research in Transplantation and Translational Immunology, Nantes Université, INSERM, UMR 1064, F-44000, Nantes, France
| | - Céline Sérazin
- Center for Research in Transplantation and Translational Immunology, Nantes Université, INSERM, UMR 1064, F-44000, Nantes, France
| | - Elodie Autrusseau
- Center for Research in Transplantation and Translational Immunology, Nantes Université, INSERM, UMR 1064, F-44000, Nantes, France
| | - Nadège Vimond
- Center for Research in Transplantation and Translational Immunology, Nantes Université, INSERM, UMR 1064, F-44000, Nantes, France
| | - Magali Giral
- Center for Research in Transplantation and Translational Immunology, Nantes Université, INSERM, UMR 1064, F-44000, Nantes, France
- Department of Nephrology, CHU Nantes, Nantes Université, ITUN, Nantes, France
| | - Ignacio Anegon
- Center for Research in Transplantation and Translational Immunology, Nantes Université, INSERM, UMR 1064, F-44000, Nantes, France
| | - Carole Guillonneau
- Center for Research in Transplantation and Translational Immunology, Nantes Université, INSERM, UMR 1064, F-44000, Nantes, France
| |
Collapse
|
5
|
Masset C, Chapelet A, Dumont R, Ville S, Garandeau C, Houzet A, Kervella D, Dantal J, Blancho G, Cantarovich D, Giral M, Figueres L. Questions about the BEST-Fluids trial. Lancet 2024; 403:909-910. [PMID: 38460985 DOI: 10.1016/s0140-6736(23)02682-x] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/24/2023] [Indexed: 03/11/2024]
Affiliation(s)
- Christophe Masset
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes 44093, France.
| | - Agnès Chapelet
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, Nantes, France
| | - Romain Dumont
- Department of Anesthesia and Critical Care, CHU de Nantes, Nantes, France
| | - Simon Ville
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes 44093, France
| | - Claire Garandeau
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, Nantes, France
| | - Aurélie Houzet
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes 44093, France
| | - Delphine Kervella
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes 44093, France
| | - Jacques Dantal
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes 44093, France
| | - Gilles Blancho
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes 44093, France
| | - Diego Cantarovich
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, Nantes, France
| | - Magali Giral
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes 44093, France
| | - Lucile Figueres
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes 44093, France
| |
Collapse
|
6
|
Viklicky O, Slatinska J, Janousek L, Rousse J, Royer PJ, Toutain PL, Cozzi E, Galli C, Evanno G, Duvaux O, Bach JM, Soulillou JP, Giral M, Vanhove B, Blancho G. First-in-human Study With LIS1, a Next-generation Porcine Low Immunogenicity Antilymphocyte Immunoglobulin in Kidney Transplantation. Transplantation 2024:00007890-990000000-00682. [PMID: 38421879 DOI: 10.1097/tp.0000000000004967] [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: 03/02/2024]
Abstract
BACKGROUND Polyclonal rabbit antithymocyte globulins (ATGs) are commonly used in organ transplantation as induction. Anti-N-glycolylneuraminic acid carbohydrate antibodies which develop in response to rabbit carbohydrate antigens might lead to unwanted systemic inflammation. LIS1, the first new generation of antilymphocyte globulins (ALGs) derived from double knockout swine, lacking carbohydrate xenoantigens was already tested in nonhuman primates and rodent models. METHODS This open-label, single-site, dose escalation, first-in-human, phase 1 study evaluated the safety, T cell depletion, pharmacokinetics, and pharmacodynamics of LIS1. In an ascending dose cohort (n = 5), a primary kidney transplant recipient at low immunologic risk (panel reactive antibody [PRA] < 20%), received LIS1 for 5 d at either 0.6, 1, 3, 6, or 8 mg/kg. After each patient completed treatment, the data safety monitoring board approved respective dose escalation. In the therapeutic dose cohort (n = 5) in patients with PRA <50% without donor specific antibodies, 2 patients received 8 mg/kg and 3 patients 10 mg/kg. RESULTS CD3+ T cell depletion <100/mm3 at day 2 was observed in all patients who received 6, 8, and 10 mg/kg of LIS1. The terminal half-life of LIS1 was 33.7 d with linearity in its disposition. Lymphocyte repopulation was fast and pretransplant lymphocyte subpopulation counts recovered within 2-4 wk. LIS1 was well tolerated, neither cytokine release syndrome nor severe thrombocytopenia or leukopenia were noticed. Antibodies to LIS1 were not detected. CONCLUSIONS In this first-in-human trial, genome-edited swine-derived polyclonal LIS1 ALG was well tolerated, did not elicit antidrug antibodies, and caused time-limited T cell depletion in low- and medium-risk kidney transplant recipients.
Collapse
Affiliation(s)
- Ondrej Viklicky
- Department of Nephrology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Janka Slatinska
- Department of Nephrology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Libor Janousek
- Department of Nephrology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | | | | | - Pierre-Louis Toutain
- Comparative Biomedical Sciences, The Royal Veterinary College, London, United Kingdom
- INTHERES, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - Emanuele Cozzi
- Transplantation Immunology Unit, Padua University Hospital, Padova, Italy
| | - Cesare Galli
- Avantea, Laboratory of Reproductive Technologies, Cremona, Italy
| | | | | | | | - Jean-Paul Soulillou
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Nantes Université, INSERM UMR1064, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Magali Giral
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Nantes Université, INSERM UMR1064, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | | | - Gilles Blancho
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Nantes Université, INSERM UMR1064, Center for Research in Transplantation and Translational Immunology, Nantes, France
| |
Collapse
|
7
|
Chetboun M, Masset C, Maanaoui M, Defrance F, Gmyr V, Raverdy V, Hubert T, Bonner C, Supiot L, Kerleau C, Blancho G, Branchereau J, Karam G, Chelghaf I, Houzet A, Giral M, Garandeau C, Dantal J, Le Mapihan K, Jannin A, Hazzan M, Caiazzo R, Kerr-Conte J, Vantyghem MC, Cantarovich D, Pattou F. Primary Graft Function and 5 Year Insulin Independence After Pancreas and Islet Transplantation for Type 1 Diabetes: A Retrospective Parallel Cohort Study. Transpl Int 2023; 36:11950. [PMID: 38213551 PMCID: PMC10783428 DOI: 10.3389/ti.2023.11950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/08/2023] [Indexed: 01/13/2024]
Abstract
In islet transplantation (ITx), primary graft function (PGF) or beta cell function measured early after last infusion is closely associated with long term clinical outcomes. We investigated the association between PGF and 5 year insulin independence rate in ITx and pancreas transplantation (PTx) recipients. This retrospective multicenter study included type 1 diabetes patients who underwent ITx in Lille and PTx in Nantes from 2000 to 2022. PGF was assessed using the validated Beta2-score and compared to normoglycemic control subjects. Subsequently, the 5 year insulin independence rates, as predicted by a validated PGF-based model, were compared to the actual rates observed in ITx and PTx patients. The study enrolled 39 ITx (23 ITA, 16 IAK), 209 PTx recipients (23 PTA, 14 PAK, 172 SPK), and 56 normoglycemic controls. Mean[SD] PGF was lower after ITx (ITA 22.3[5.2], IAK 24.8[6.4], than after PTx (PTA 38.9[15.3], PAK 36.8[9.0], SPK 38.7[10.5]), and lower than mean beta-cell function measured in normoglycemic control: 36.6[4.3]. The insulin independence rates observed at 5 years after PTA and PAK aligned with PGF predictions, and was higher after SPK. Our results indicate a similar relation between PGF and 5 year insulin independence in ITx and solitary PTx, shedding new light on long-term transplantation outcomes.
Collapse
Affiliation(s)
- Mikael Chetboun
- Univ Lille, U1190 - EGID, Lille, France
- Inserm, U1190, Lille, France
- Institut Pasteur de Lille, Lille, France
- CHU Lille, Department of General, Endocrine and Metabolic Surgery, Lille, France
| | - Christophe Masset
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie clinique, CHU Nantes, Nantes, France
- Nantes Université, Inserm, UMR 1064, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Mehdi Maanaoui
- Univ Lille, U1190 - EGID, Lille, France
- Inserm, U1190, Lille, France
- Institut Pasteur de Lille, Lille, France
- CHU Lille, Department of Nephrology, Lille, France
| | - Frédérique Defrance
- CHU Lille, Department of Endocrinology, Diabetology and Metabolism, Lille, France
| | - Valéry Gmyr
- Univ Lille, U1190 - EGID, Lille, France
- Inserm, U1190, Lille, France
- Institut Pasteur de Lille, Lille, France
| | - Violeta Raverdy
- Univ Lille, U1190 - EGID, Lille, France
- Inserm, U1190, Lille, France
- Institut Pasteur de Lille, Lille, France
- CHU Lille, Department of General, Endocrine and Metabolic Surgery, Lille, France
| | - Thomas Hubert
- Univ Lille, U1190 - EGID, Lille, France
- Inserm, U1190, Lille, France
- Institut Pasteur de Lille, Lille, France
| | - Caroline Bonner
- Univ Lille, U1190 - EGID, Lille, France
- Inserm, U1190, Lille, France
- Institut Pasteur de Lille, Lille, France
| | - Lisa Supiot
- Nantes Université, Inserm, UMR 1064, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Clarisse Kerleau
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie clinique, CHU Nantes, Nantes, France
| | - Gilles Blancho
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie clinique, CHU Nantes, Nantes, France
- Nantes Université, Inserm, UMR 1064, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Julien Branchereau
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie clinique, CHU Nantes, Nantes, France
- Nantes Université, Inserm, UMR 1064, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Georges Karam
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie clinique, CHU Nantes, Nantes, France
- Nantes Université, Inserm, UMR 1064, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Ismaël Chelghaf
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie clinique, CHU Nantes, Nantes, France
| | - Aurélie Houzet
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie clinique, CHU Nantes, Nantes, France
| | - Magali Giral
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie clinique, CHU Nantes, Nantes, France
- Nantes Université, Inserm, UMR 1064, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Claire Garandeau
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie clinique, CHU Nantes, Nantes, France
| | - Jacques Dantal
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie clinique, CHU Nantes, Nantes, France
- Nantes Université, Inserm, UMR 1064, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Kristell Le Mapihan
- CHU Lille, Department of Endocrinology, Diabetology and Metabolism, Lille, France
| | - Arnaud Jannin
- CHU Lille, Department of Endocrinology, Diabetology and Metabolism, Lille, France
| | - Marc Hazzan
- CHU Lille, Department of Nephrology, Lille, France
| | - Robert Caiazzo
- Univ Lille, U1190 - EGID, Lille, France
- Inserm, U1190, Lille, France
- Institut Pasteur de Lille, Lille, France
- CHU Lille, Department of General, Endocrine and Metabolic Surgery, Lille, France
| | - Julie Kerr-Conte
- Univ Lille, U1190 - EGID, Lille, France
- Inserm, U1190, Lille, France
- Institut Pasteur de Lille, Lille, France
| | - Marie-Christine Vantyghem
- Univ Lille, U1190 - EGID, Lille, France
- Inserm, U1190, Lille, France
- Institut Pasteur de Lille, Lille, France
- CHU Lille, Department of Endocrinology, Diabetology and Metabolism, Lille, France
| | - Diego Cantarovich
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie clinique, CHU Nantes, Nantes, France
| | - François Pattou
- Univ Lille, U1190 - EGID, Lille, France
- Inserm, U1190, Lille, France
- Institut Pasteur de Lille, Lille, France
- CHU Lille, Department of General, Endocrine and Metabolic Surgery, Lille, France
| |
Collapse
|
8
|
Braud P, Joher N, Blancho G, Grimbert P, Anne LB, Garandeau C, Cantarovich D, Houzet A, Giral M, Dantal J, Matignon M, Masset C. Evolution of anti-spike responses to SARS-CoV-2 vaccination within 6 months post-transplantation in patients previously vaccinated while on the transplant waiting list. Clin Transplant 2023; 37:e15120. [PMID: 37658833 DOI: 10.1111/ctr.15120] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Pierre Braud
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Nizar Joher
- Department of Nephrology and Transplantation, Assistance Publique Hôpitaux de Paris, Hôpital Henri Mondor, Créteil, France
| | - Gilles Blancho
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Philippe Grimbert
- Department of Nephrology and Transplantation, Assistance Publique Hôpitaux de Paris, Hôpital Henri Mondor, Créteil, France
| | - Le Bouter Anne
- Laboratory of Virology, Assistance Publique Hôpitaux de Paris, Hôpital Henri Mondor, Créteil, France
| | - Claire Garandeau
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Diego Cantarovich
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Aurélie Houzet
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Magali Giral
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Jacques Dantal
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Marie Matignon
- Department of Nephrology and Transplantation, Assistance Publique Hôpitaux de Paris, Hôpital Henri Mondor, Créteil, France
| | - Christophe Masset
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
| |
Collapse
|
9
|
Ba R, Durand A, Mauduit V, Chauveau C, Le Bas-Bernardet S, Salle S, Guérif P, Morin M, Petit C, Douillard V, Rousseau O, Blancho G, Kerleau C, Vince N, Giral M, Gourraud PA, Limou S. KiT-GENIE, the French genetic biobank of kidney transplantation. Eur J Hum Genet 2023; 31:1291-1299. [PMID: 36737541 PMCID: PMC10620190 DOI: 10.1038/s41431-023-01294-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/16/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
KiT-GENIE is a monocentric DNA biobank set up to consolidate the very rich and homogeneous DIVAT French cohort of kidney donors and recipients (D/R) in order to explore the molecular factors involved in kidney transplantation outcomes. We collected DNA samples for kidney transplantations performed in Nantes, and we leveraged GWAS genotyping data for securing high-quality genetic data with deep SNP and HLA annotations through imputations and for inferring D/R genetic ancestry. Overall, the biobank included 4217 individuals (n = 1945 D + 2,272 R, including 1969 D/R pairs), 7.4 M SNPs and over 200 clinical variables. KiT-GENIE represents an accurate snapshot of kidney transplantation clinical practice in Nantes between 2002 and 2018, with an enrichment in living kidney donors (17%) and recipients with focal segmental glomerulosclerosis (4%). Recipients were predominantly male (63%), of European ancestry (93%), with a mean age of 51yo and 86% experienced their first graft over the study period. D/R pairs were 93% from European ancestry, and 95% pairs exhibited at least one HLA allelic mismatch. The mean follow-up time was 6.7 years with a hindsight up to 25 years. Recipients experienced biopsy-proven rejection and graft loss for 16.6% and 21.3%, respectively. KiT-GENIE constitutes one of the largest kidney transplantation genetic cohorts worldwide to date. It includes homogeneous high-quality clinical and genetic data for donors and recipients, hence offering a unique opportunity to investigate immunogenetic and genetic factors, as well as donor-recipient interactions and mismatches involved in rejection, graft survival, primary disease recurrence and other comorbidities.
Collapse
Affiliation(s)
- Rokhaya Ba
- Nantes Université, Centrale Nantes, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, F-44000, Nantes, France
| | - Axelle Durand
- Nantes Université, Centrale Nantes, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, F-44000, Nantes, France
| | - Vincent Mauduit
- Nantes Université, Centrale Nantes, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, F-44000, Nantes, France
| | - Christine Chauveau
- Nantes Université, Centrale Nantes, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, F-44000, Nantes, France
| | - Stéphanie Le Bas-Bernardet
- Nantes Université, Centrale Nantes, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, F-44000, Nantes, France
| | - Sonia Salle
- Nantes Université, Centrale Nantes, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, F-44000, Nantes, France
| | - Pierrick Guérif
- CHU Nantes, Nantes Université, Service de Néphrologie-Immunologie Clinique, ITUN, F-44000, Nantes, France
| | - Martin Morin
- Nantes Université, Centrale Nantes, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, F-44000, Nantes, France
| | - Clémence Petit
- Nantes Université, Centrale Nantes, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, F-44000, Nantes, France
- CHU Nantes, Nantes Université, Service de Néphrologie-Immunologie Clinique, ITUN, F-44000, Nantes, France
| | - Venceslas Douillard
- Nantes Université, Centrale Nantes, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, F-44000, Nantes, France
| | - Olivia Rousseau
- Nantes Université, Centrale Nantes, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, F-44000, Nantes, France
| | - Gilles Blancho
- Nantes Université, Centrale Nantes, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, F-44000, Nantes, France
- CHU Nantes, Nantes Université, Service de Néphrologie-Immunologie Clinique, ITUN, F-44000, Nantes, France
| | - Clarisse Kerleau
- CHU Nantes, Nantes Université, Service de Néphrologie-Immunologie Clinique, ITUN, F-44000, Nantes, France
| | - Nicolas Vince
- Nantes Université, Centrale Nantes, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, F-44000, Nantes, France
| | - Magali Giral
- Nantes Université, Centrale Nantes, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, F-44000, Nantes, France
- CHU Nantes, Nantes Université, Service de Néphrologie-Immunologie Clinique, ITUN, F-44000, Nantes, France
| | - Pierre-Antoine Gourraud
- Nantes Université, Centrale Nantes, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, F-44000, Nantes, France
| | - Sophie Limou
- Nantes Université, Centrale Nantes, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, F-44000, Nantes, France.
| |
Collapse
|
10
|
Supiot L, Ville S, Kerleau C, Garandeau C, Houzet A, Djobo AM, Kervella D, Giral M, Dantal J, Blancho G, Cantarovich D, Masset C. WBC and Platelet Evolution After Pancreas Transplantation Suggests 2 Phenotypes of Allograft Thrombosis. Transplantation 2023; 107:e320-e322. [PMID: 37638883 DOI: 10.1097/tp.0000000000004791] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Lisa Supiot
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Simon Ville
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1604, Nantes, France
| | - Clarisse Kerleau
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1604, Nantes, France
| | - Claire Garandeau
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Aurélie Houzet
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Aboudou-Moumouni Djobo
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Delphine Kervella
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1604, Nantes, France
| | - Magali Giral
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1604, Nantes, France
| | - Jacques Dantal
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1604, Nantes, France
| | - Gilles Blancho
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1604, Nantes, France
| | - Diego Cantarovich
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Christophe Masset
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1604, Nantes, France
| |
Collapse
|
11
|
Graveleau A, Kervella D, Kerleau C, Lavallée E, Chelghaf I, de Vergie S, Karam G, Perrouin-Verbe MA, Rigaud J, Blancho G, Giral M, Branchereau J. [Surgical outcomes and complications following third kidney transplantation]. Prog Urol 2023; 33:427-436. [PMID: 37169706 DOI: 10.1016/j.purol.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND After two consecutive kidney transplant failures, a third kidney transplantation improves survival for patients on the waiting list. The surgical outcomes and complications of third kidney transplantations remain poorly known. METHODS We analyzed the last 100 third kidney transplantations performed in our center between January 2000 and August 2018. The data, relating to donors and recipients, were extracted retrospectively from medical records and from the prospective DIVAT database (computerized and validated data in transplantation). Continuous variables are expressed as means, medians, first and third quartiles (median, [Q1;Q3]). Categorical variables are expressed as percentages. Patient and transplant survivals were calculated using the Kaplan-Meier method. RESULTS Mean age of recipients was 46.4 years (47, [36;53]). Thirty-five percent had kidney failure due to urinary tract malformations. Mean age of donors was 48.2 years (52, [39.75; 58]) with 63% of donors with standard criteria. Mean cold ischemia time was 22.4hours (21, [16.5; 29.2]). Surgical mortality rate was 2% and surgical complication rate was 45%. Third kidney transplants survival was 73.1% and 58.8% at 5 years and 10 years. Mortality rate with a functioning transplant was 18%. CONCLUSION A third kidney transplant offers satisfactory functional outcomes but remains associated with high morbi-mortality and a significant death rate with a functioning transplant. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Aurélien Graveleau
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Delphine Kervella
- Service de néphrologie et de transplantation, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Clarisse Kerleau
- Service de néphrologie et de transplantation, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Etienne Lavallée
- Département de chirurgie et centre de recherche sur le cancer, division d'urologie, université Laval, Québec, Canada
| | - Ismael Chelghaf
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Stéphane de Vergie
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Georges Karam
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | | | - Jérôme Rigaud
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Gilles Blancho
- Service de néphrologie et de transplantation, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Magali Giral
- Service de néphrologie et de transplantation, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Julien Branchereau
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France.
| |
Collapse
|
12
|
Sailliet N, Mai HL, Dupuy A, Tilly G, Fourgeux C, Braud M, Giral M, Robert JM, Degauque N, Danger R, Poschmann J, Brouard S. Human granzyme B regulatory B cells prevent effector CD4+CD25- T cell proliferation through a mechanism dependent from lymphotoxin alpha. Front Immunol 2023; 14:1183714. [PMID: 37588598 PMCID: PMC10425555 DOI: 10.3389/fimmu.2023.1183714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/05/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction Human Granzyme B (GZMB) regulatory B cells (Bregs) have suppressive properties on CD4+ effector T cells by a mechanism partially dependent on GZMB. Moreover, these cells may be easily induced in vitro making them interesting for cell therapy. Methods We characterized this population of in vitro induced GZMB+Bregs using single cell transcriptomics. To investigate their regulatory properties, Bregs or total B cells were also co-cultured with T cells and scRNAseq was used to identify receptor ligand interactions and to reveal gene expression changes in the T cells. Results We find that Bregs exhibit a unique set of 149 genes differentially expressed and which are implicated in proliferation, apoptosis, metabolism, and altered antigen presentation capacity consistent with their differentiated B cells profile. Notably, Bregs induced a strong inhibition of T cell genes associated to proliferation, activation, inflammation and apoptosis compared to total B cells. We identified and validated 5 receptor/ligand interactions between Bregs and T cells. Functional analysis using specific inhibitors was used to test their suppressive properties and we identified Lymphotoxin alpha (LTA) as a new and potent Breg ligand implicated in Breg suppressive properties. Discussion We report for the first time for a role of LTA in GZMB+Bregs as an enhancer of GZMB expression, and involved in the suppressive properties of GZMB+Bregs in human. The exact mechanism of LTA/GZMB function in this specific subset of Bregs remains to be determined.
Collapse
Affiliation(s)
- Nicolas Sailliet
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Hoa-Le Mai
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Amandine Dupuy
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Gaëlle Tilly
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Cynthia Fourgeux
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Martin Braud
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Magali Giral
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Jean-Michel Robert
- Institut De Recherche En Santé 2, Cibles Et Médicaments Des Infections Et De l’Immunité IICiMed-UR1155, Nantes Université, Nantes, France
| | - Nicolas Degauque
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Richard Danger
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Jeremie Poschmann
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Sophie Brouard
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| |
Collapse
|
13
|
Gaiffe E, Colladant M, Desmaret M, Bamoulid J, Leroux F, Laheurte C, Brouard S, Giral M, Saas P, Courivaud C, Degauque N, Ducloux D. Pre-transplant immune profile defined by principal component analysis predicts acute rejection after kidney transplantation. Front Immunol 2023; 14:1192440. [PMID: 37497224 PMCID: PMC10367005 DOI: 10.3389/fimmu.2023.1192440] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
Background Acute rejection persists as a frequent complication after kidney transplantation. Defining an at-risk immune profile would allow better preventive approaches. Methods We performed unsupervised hierarchical clustering analysis on pre-transplant immunological phenotype in 1113 renal transplant recipients from the ORLY-EST cohort. Results We identified three immune profiles correlated with clinical phenotypes. A memory immune cluster was defined by memory CD4+T cell expansion and decreased naïve CD4+T cell. An activated immune cluster was characterized by an increase in CD8+T cells and a decreased CD4/CD8 ratio. A naïve immune cluster was mainly defined by increased naïve CD4+T cells. Patients from the memory immune profile tend to be older and to have diabetes whereas those from the activated immune profile were younger and more likely to have pre-transplant exposure to CMV. Patients from the activated immune profile were more prone to experience acute rejection than those from other clusters [(HR=1.69, 95%IC[1.05-2.70], p=0.030) and (HR=1.85; 95%IC[1.16-3.00], p=0.011). In the activated immune profile, those without previous exposure to CMV (24%) were at very high risk of acute rejection (27 vs 16%, HR=1.85; 95%IC[1.04-3.33], p=0.039). Conclusion Immune profile determination based on principal component analysis defines clinically different sub-groups and discriminate a population at high-risk of acute rejection.
Collapse
Affiliation(s)
- Emilie Gaiffe
- Besançon University Hospital, INSERM CIC-1431, Besançon, France
- Univ. Franche-Comté, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, Unité Mixte de Recherche (UMR) 1098, RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Mathilde Colladant
- Univ. Franche-Comté, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, Unité Mixte de Recherche (UMR) 1098, RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
- Besançon University Hospital, Department of Nephrology, Besançon, France
| | - Maxime Desmaret
- Besançon University Hospital, INSERM CIC-1431, Besançon, France
- Univ. Franche-Comté, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, Unité Mixte de Recherche (UMR) 1098, RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Jamal Bamoulid
- Univ. Franche-Comté, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, Unité Mixte de Recherche (UMR) 1098, RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
- Besançon University Hospital, Department of Nephrology, Besançon, France
| | - Franck Leroux
- Besançon University Hospital, INSERM CIC-1431, Besançon, France
| | - Caroline Laheurte
- Univ. Franche-Comté, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, Unité Mixte de Recherche (UMR) 1098, RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Sophie Brouard
- Centre Hospitalier Universitaire (CHU) Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, Unité Mixte de Recherche (UMR) 1064, Institut de Transplantation Université de Nantes (ITUN), Nantes, France
| | - Magali Giral
- Centre Hospitalier Universitaire (CHU) Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, Unité Mixte de Recherche (UMR) 1064, Institut de Transplantation Université de Nantes (ITUN), Nantes, France
| | - Philippe Saas
- Univ. Franche-Comté, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, Unité Mixte de Recherche (UMR) 1098, RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Cécile Courivaud
- Univ. Franche-Comté, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, Unité Mixte de Recherche (UMR) 1098, RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
- Besançon University Hospital, Department of Nephrology, Besançon, France
| | - Nicolas Degauque
- Centre Hospitalier Universitaire (CHU) Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, Unité Mixte de Recherche (UMR) 1064, Institut de Transplantation Université de Nantes (ITUN), Nantes, France
| | - Didier Ducloux
- Besançon University Hospital, INSERM CIC-1431, Besançon, France
- Univ. Franche-Comté, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, Unité Mixte de Recherche (UMR) 1098, RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
- Besançon University Hospital, Department of Nephrology, Besançon, France
| |
Collapse
|
14
|
Massart A, Danger R, Olsen C, Emond MJ, Viklicky O, Jacquemin V, Soblet J, Duerinckx S, Croes D, Perazzolo C, Hruba P, Daneels D, Caljon B, Sever MS, Pascual J, Miglinas M, Pirson I, Ghisdal L, Smits G, Giral M, Abramowicz D, Abramowicz M, Brouard S. An exome-wide study of renal operational tolerance. Front Med (Lausanne) 2023; 9:976248. [PMID: 37265662 PMCID: PMC10230038 DOI: 10.3389/fmed.2022.976248] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/31/2022] [Indexed: 06/03/2023] Open
Abstract
Background Renal operational tolerance is a rare and beneficial state of prolonged renal allograft function in the absence of immunosuppression. The underlying mechanisms are unknown. We hypothesized that tolerance might be driven by inherited protein coding genetic variants with large effect, at least in some patients. Methods We set up a European survey of over 218,000 renal transplant recipients and collected DNAs from 40 transplant recipients who maintained good allograft function without immunosuppression for at least 1 year. We performed an exome-wide association study comparing the distribution of moderate to high impact variants in 36 tolerant patients, selected for genetic homogeneity using principal component analysis, and 192 controls, using an optimal sequence-kernel association test adjusted for small samples. Results We identified rare variants of HOMER2 (3/36, FDR 0.0387), IQCH (5/36, FDR 0.0362), and LCN2 (3/36, FDR 0.102) in 10 tolerant patients vs. 0 controls. One patient carried a variant in both HOMER2 and LCN2. Furthermore, the three genes showed an identical variant in two patients each. The three genes are expressed at the primary cilium, a key structure in immune responses. Conclusion Rare protein coding variants are associated with operational tolerance in a sizable portion of patients. Our findings have important implications for a better understanding of immune tolerance in transplantation and other fields of medicine.ClinicalTrials.gov, identifier: NCT05124444.
Collapse
Affiliation(s)
- Annick Massart
- Human Genetics Unit, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
- Department of Nephrology, Antwerp University Hospital and Laboratory of Experimental Medicine, University of Antwerp, Antwerp, Belgium
| | - Richard Danger
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, CR2TI, UMR 1064, ITUN, Nantes, France
| | - Catharina Olsen
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
- Brussels Interuniversity Genomics High Throughput Core (BRIGHTcore), VUB-ULB, Brussels, Belgium
- Center for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, UZ Brussel, Brussels, Belgium
| | - Mary J. Emond
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Ondrej Viklicky
- Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Valérie Jacquemin
- Human Genetics Unit, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
| | - Julie Soblet
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
- Department of Genetics, Hôpital Erasme, ULB Center of Human Genetics, Université Libre de Bruxelles, Brussels, Belgium
- Department of Genetics, Hôpital Universitaire des Enfants Reine Fabiola, ULB Center of Human Genetics, Université Libre de Bruxelles, Brussels, Belgium
| | - Sarah Duerinckx
- Human Genetics Unit, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
| | - Didier Croes
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
- Brussels Interuniversity Genomics High Throughput Core (BRIGHTcore), VUB-ULB, Brussels, Belgium
- Center for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, UZ Brussel, Brussels, Belgium
- Center for Human Genetics, Clinique Universitaires Saint Luc, Brussels, Belgium
| | - Camille Perazzolo
- Human Genetics Unit, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Petra Hruba
- Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Dorien Daneels
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
- Brussels Interuniversity Genomics High Throughput Core (BRIGHTcore), VUB-ULB, Brussels, Belgium
- Center for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, UZ Brussel, Brussels, Belgium
| | - Ben Caljon
- Brussels Interuniversity Genomics High Throughput Core (BRIGHTcore), VUB-ULB, Brussels, Belgium
- Center for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, UZ Brussel, Brussels, Belgium
| | - Mehmet Sukru Sever
- Istanbul Tip Fakültesi, Istanbul School of Medicine, Internal Medicine, Nephrology, Istanbul, Türkiye
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, Barcelona, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marius Miglinas
- Nephrology Center, Santaros Klinikos, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | | | - Isabelle Pirson
- Human Genetics Unit, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lidia Ghisdal
- Department of Nephrology, Hospital Centre EpiCURA, Baudour, Belgium
| | - Guillaume Smits
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
- Department of Genetics, Hôpital Erasme, ULB Center of Human Genetics, Université Libre de Bruxelles, Brussels, Belgium
| | - Magali Giral
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, CR2TI, UMR 1064, ITUN, Nantes, France
- CHU Nantes, Centre d'Investigation Clinique en Biothérapie, Centre de Ressources Biologiques (CRB), Nantes, France
- LabEx IGO “Immunotherapy, Graft, Oncology”, Nantes, France
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital and Laboratory of Experimental Medicine, University of Antwerp, Antwerp, Belgium
| | - Marc Abramowicz
- Human Genetics Unit, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
- Department of Genetic Medicine and Development, Faculty of Medicine, Université de Geneve, Geneva, Switzerland
| | - Sophie Brouard
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, CR2TI, UMR 1064, ITUN, Nantes, France
- CHU Nantes, Centre d'Investigation Clinique en Biothérapie, Centre de Ressources Biologiques (CRB), Nantes, France
- LabEx IGO “Immunotherapy, Graft, Oncology”, Nantes, France
| |
Collapse
|
15
|
Yoo D, Goutaudier V, Divard G, Gueguen J, Astor BC, Aubert O, Raynaud M, Demir Z, Hogan J, Weng P, Smith J, Garro R, Warady BA, Zahr RS, Sablik M, Twombley K, Couzi L, Berney T, Boyer O, Duong-Van-Huyen JP, Giral M, Alsadi A, Gourraud PA, Morelon E, Le Quintrec M, Brouard S, Legendre C, Anglicheau D, Villard J, Zhong W, Kamar N, Bestard O, Djamali A, Budde K, Haas M, Lefaucheur C, Rabant M, Loupy A. An automated histological classification system for precision diagnostics of kidney allografts. Nat Med 2023; 29:1211-1220. [PMID: 37142762 DOI: 10.1038/s41591-023-02323-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 03/28/2023] [Indexed: 05/06/2023]
Abstract
For three decades, the international Banff classification has been the gold standard for kidney allograft rejection diagnosis, but this system has become complex over time with the integration of multimodal data and rules, leading to misclassifications that can have deleterious therapeutic consequences for patients. To improve diagnosis, we developed a decision-support system, based on an algorithm covering all classification rules and diagnostic scenarios, that automatically assigns kidney allograft diagnoses. We then tested its ability to reclassify rejection diagnoses for adult and pediatric kidney transplant recipients in three international multicentric cohorts and two large prospective clinical trials, including 4,409 biopsies from 3,054 patients (62.05% male and 37.95% female) followed in 20 transplant referral centers in Europe and North America. In the adult kidney transplant population, the Banff Automation System reclassified 83 out of 279 (29.75%) antibody-mediated rejection cases and 57 out of 105 (54.29%) T cell-mediated rejection cases, whereas 237 out of 3,239 (7.32%) biopsies diagnosed as non-rejection by pathologists were reclassified as rejection. In the pediatric population, the reclassification rates were 8 out of 26 (30.77%) for antibody-mediated rejection and 12 out of 39 (30.77%) for T cell-mediated rejection. Finally, we found that reclassification of the initial diagnoses by the Banff Automation System was associated with an improved risk stratification of long-term allograft outcomes. This study demonstrates the potential of an automated histological classification to improve transplant patient care by correcting diagnostic errors and standardizing allograft rejection diagnoses.ClinicalTrials.gov registration: NCT05306795 .
Collapse
Affiliation(s)
- Daniel Yoo
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Valentin Goutaudier
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
- Department of Kidney Transplantation, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Gillian Divard
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
- Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Juliette Gueguen
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Brad C Astor
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Olivier Aubert
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
- Department of Kidney Transplantation, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Marc Raynaud
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Zeynep Demir
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
- Pediatric Hepatology Unit-Liver Transplantation, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Julien Hogan
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
- Division of Pediatric Nephrology, Robert Debré Hospital, APHP, Paris, France
| | - Patricia Weng
- Pediatric Nephrology, David Geffen School of Medicine at UCLA, UCLA Mattel Children's Hospital, Los Angeles, CA, USA
| | - Jodi Smith
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Rouba Garro
- Division of Pediatric Nephrology, Emory University School of Medicine, Children's Pediatric Institute, Atlanta, GA, USA
| | - Bradley A Warady
- Division of Pediatric Nephrology, University of Kansas City, Children's Mercy Hospital, Kansas City, MO, USA
| | - Rima S Zahr
- Division of Pediatric Nephrology and Hypertension, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Marta Sablik
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Katherine Twombley
- Acute Dialysis Units, Pediatric Kidney Transplant, Medical University of South Carolina, Charleston, SC, USA
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis and Apheresis, CHU Bordeaux, Bordeaux, France
| | - Thierry Berney
- Division of Abdominal and Transplantation Surgery, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Olivia Boyer
- Division of Pediatric Nephrology, Necker Hospital, Université Paris Cité, Paris, France
| | - Jean-Paul Duong-Van-Huyen
- Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Magali Giral
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, France
| | - Alaa Alsadi
- Department of Pathology, University of Wisconsin, Madison, WI, USA
| | - Pierre A Gourraud
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, France
| | - Emmanuel Morelon
- Department of Transplantation, Edouard Herriot University Hospital, Hospices Civils de Lyon, University Lyon, University of Lyon I, Lyon, France
| | - Moglie Le Quintrec
- Department of Nephrology, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Sophie Brouard
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, France
| | - Christophe Legendre
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
- Department of Kidney Transplantation, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Dany Anglicheau
- Department of Kidney Transplantation, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jean Villard
- Division of Transplantation Immunology, University Hospital of Geneva, Geneva, Switzerland
| | - Weixiong Zhong
- Department of Pathology, University of Wisconsin, Madison, WI, USA
| | - Nassim Kamar
- Department of Nephrology-Dialysis-Transplantation, Centre Hospitalier, Universitaire de Toulouse, Toulouse, France
| | - Oriol Bestard
- Department of Nephrology and Kidney Transplantation, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Arjang Djamali
- Department of Medicine, Maine Medical Center, Portland, ME, USA
| | - Klemens Budde
- Department of Nephrology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
| | - Mark Haas
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Carmen Lefaucheur
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
- Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Marion Rabant
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
- Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Alexandre Loupy
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France.
- Department of Kidney Transplantation, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
| |
Collapse
|
16
|
Moreau A, Kervella D, Bouchet-Delbos L, Braudeau C, Saïagh S, Guérif P, Limou S, Moreau A, Bercegeay S, Streitz M, Sawitzki B, James B, Harden PN, Game D, Tang Q, Markmann JF, Roberts ISD, Geissler EK, Dréno B, Josien R, Cuturi MC, Blancho G, Branchereau J, Cantarovich D, Chapelet A, Dantal J, Deltombe C, Figueres L, Gaisne R, Garandeau C, Giral M, Gourraud-Vercel C, Hourmant M, Karam G, Kerleau C, Kervella D, Masset C, Meurette A, Ville S, Kandell C, Moreau A, Renaudin K, Delbos F, Walencik A, Devis A. A Phase I/IIa study of autologous tolerogenic dendritic cells immunotherapy in kidney transplant recipients. Kidney Int 2023; 103:627-637. [PMID: 36306921 DOI: 10.1016/j.kint.2022.08.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/09/2022]
Abstract
Kidney transplant survival is shortened by chronic rejection and side effects of standard immunosuppressive drugs. Cell-based immunotherapy with tolerogenic dendritic cells has long been recognized as a promising approach to reduce general immunosuppression. Published trials report the safety and the absence of therapy-related adverse reactions in patients treated with tolerogenic dendritic cells suffering from several inflammatory diseases. Here, we present the first phase I clinical trial results using human autologous tolerogenic dendritic cells (ATDC) in kidney transplantation. Eight patients received ATDC the day before transplantation in conjunction with standard steroids, mycophenolate mofetil and tacrolimus immunosuppression with an option to taper mycophenolate mofetil. ATDC preparations were manufactured in a Good Manufacturing Practice-compliant facility and fulfilled cell count, viability, purity and identity criteria for release. A control group of nine patients received the same standard immunosuppression, except basiliximab induction replaced ATDC therapy and mycophenolate tapering was not allowed. During the three-year follow-up, no deaths occurred and there was 100% graft survival. No significant increase of adverse events was associated with ATDC infusion. Episodes of rejection were observed in two patients from the ATDC group and one patient from the control group. However, all rejections were successfully treated by glucocorticoids. Mycophenolate was successfully reduced/stopped in five patients from the ATDC group, allowing tacrolimus monotherapy for two of them. Regarding immune monitoring, reduced CD8 T cell activation markers and increased Foxp3 expression were observed in the ATDC group. Thus, our results demonstrate ATDC administration safety in kidney-transplant recipients.
Collapse
Affiliation(s)
- Aurélie Moreau
- Inserm, Nantes Université, Centre Hospitalier Universitaire Nantes, Centre de Recherche Translationnelle en Transplantation et Immunologie, Unite Mixte de Recherche 1064, Institut de Transplantation Urologie Nephrologie, Nantes, France.
| | - Delphine Kervella
- Inserm, Nantes Université, Centre Hospitalier Universitaire Nantes, Centre de Recherche Translationnelle en Transplantation et Immunologie, Unite Mixte de Recherche 1064, Institut de Transplantation Urologie Nephrologie, Nantes, France; Centre Hospitalier Universitaire Nantes, Nantes Université, Service de Néphrologie et d'immunologie clinique, Institut de Transplantation Urologie Nephrologie, Nantes, France
| | - Laurence Bouchet-Delbos
- Inserm, Nantes Université, Centre Hospitalier Universitaire Nantes, Centre de Recherche Translationnelle en Transplantation et Immunologie, Unite Mixte de Recherche 1064, Institut de Transplantation Urologie Nephrologie, Nantes, France
| | - Cécile Braudeau
- Inserm, Nantes Université, Centre Hospitalier Universitaire Nantes, Centre de Recherche Translationnelle en Transplantation et Immunologie, Unite Mixte de Recherche 1064, Institut de Transplantation Urologie Nephrologie, Nantes, France; Centre Hospitalier Universitaire Nantes, Nantes Université, Laboratoire d'Immunologie, Center for Immuno Monitoring Nantes Atlantic, Nantes, France
| | - Soraya Saïagh
- Centre Hospitalier Universitaire Nantes, Nantes Université, Unité de Thérapie Cellulaire et Génique Good Manufacturing Practice, Nantes, France
| | - Pierrick Guérif
- Centre Hospitalier Universitaire Nantes, Nantes Université, Service de Néphrologie et d'immunologie clinique, Institut de Transplantation Urologie Nephrologie, Nantes, France
| | - Sophie Limou
- Inserm, Nantes Université, Centre Hospitalier Universitaire Nantes, Centre de Recherche Translationnelle en Transplantation et Immunologie, Unite Mixte de Recherche 1064, Institut de Transplantation Urologie Nephrologie, Nantes, France
| | - Anne Moreau
- Centre Hospitalier Universitaire Nantes, Nantes Université, Laboratoire d'anatomopathologie, Nantes, France
| | - Sylvain Bercegeay
- Centre Hospitalier Universitaire Nantes, Nantes Université, Unité de Thérapie Cellulaire et Génique Good Manufacturing Practice, Nantes, France
| | - Mathias Streitz
- Institute of Medical Immunology, Charité University of Medicine, Berlin, Germany; Department of Experimental Animal Facilities and Biorisk Management, Friedrich-Loeffler Institut, Greifswald-Insel Riems, Greifswald, Germany
| | - Birgit Sawitzki
- Institute of Medical Immunology, Charité University of Medicine, Berlin, Germany
| | - Ben James
- Department of surgery, Division of Experimental Surgery, University of Regensburg, Regensburg, Germany
| | - Paul N Harden
- Oxford Transplant Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Game
- Department of Transplantation, Guys and St Thomas's Hospital NHS Trust, London, UK
| | - Qizhi Tang
- Department of Surgery, University of California San Francisco Transplantation Research Lab, University of California, San Francisco, California, USA
| | - James F Markmann
- Center for Transplantation Sciences, Mass General Hospital, Boston, Massachusetts, USA
| | - Ian S D Roberts
- Department of Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Edward K Geissler
- Department of surgery, Division of Experimental Surgery, University of Regensburg, Regensburg, Germany
| | - Brigitte Dréno
- Centre Hospitalier Universitaire Nantes, Nantes Université, Unité de Thérapie Cellulaire et Génique Good Manufacturing Practice, Nantes, France
| | - Régis Josien
- Inserm, Nantes Université, Centre Hospitalier Universitaire Nantes, Centre de Recherche Translationnelle en Transplantation et Immunologie, Unite Mixte de Recherche 1064, Institut de Transplantation Urologie Nephrologie, Nantes, France; Centre Hospitalier Universitaire Nantes, Nantes Université, Laboratoire d'Immunologie, Center for Immuno Monitoring Nantes Atlantic, Nantes, France
| | - Maria-Cristina Cuturi
- Inserm, Nantes Université, Centre Hospitalier Universitaire Nantes, Centre de Recherche Translationnelle en Transplantation et Immunologie, Unite Mixte de Recherche 1064, Institut de Transplantation Urologie Nephrologie, Nantes, France
| | - Gilles Blancho
- Inserm, Nantes Université, Centre Hospitalier Universitaire Nantes, Centre de Recherche Translationnelle en Transplantation et Immunologie, Unite Mixte de Recherche 1064, Institut de Transplantation Urologie Nephrologie, Nantes, France; Centre Hospitalier Universitaire Nantes, Nantes Université, Service de Néphrologie et d'immunologie clinique, Institut de Transplantation Urologie Nephrologie, Nantes, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Danger R, Le Berre L, Cadoux M, Kerleau C, Papuchon E, Mai HL, Nguyen TVH, Guérif P, Morelon E, Thaunat O, Legendre C, Anglicheau D, Lefaucheur C, Couzi L, Del Bello A, Kamar N, Le Quintrec M, Goutaudier V, Renaudin K, Giral M, Brouard S. Subclinical rejection-free diagnostic after kidney transplantation using blood gene expression. Kidney Int 2023; 103:1167-1179. [PMID: 36990211 DOI: 10.1016/j.kint.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 02/16/2023] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Abstract
We previously established a six-gene-based blood score associated with operational tolerance in kidney transplantation which was decreased in patients developing anti-HLA donor-specific antibodies (DSA). Herein, we aimed to confirm that this score is associated with immunological events and risk of rejection. We measured this using quantitative PCR (qPCR) and NanoString methods from an independent multicenter cohort of 588 kidney transplant recipients with paired blood samples and biopsies at one year after transplantation validating its association with pre-existing and de novo DSA. From 441 patients with protocol biopsy, there was a significant decrease of the score of tolerance in 45 patients with biopsy-proven subclinical rejection (SCR), a major threat associated with pejorative allograft outcomes that prompted an SCR score refinement. This refinement used only two genes, AKR1C3 and TCL1A, and four clinical parameters (previous experience of rejection, previous transplantation, sex of recipient and tacrolimus uptake). This refined SCR score was able to identify patients unlikely to develop SCR with a C-statistic of 0.864 and a negative predictive value of 98.3%. The SCR score was validated in an external laboratory, with two methods (qPCR and NanoString), and on 447 patients from an independent and multicenter cohort. Moreover, this score allowed reclassifying patients with discrepancies between the DSA presence and the histological diagnosis of antibody mediated rejection unlike kidney function. Thus, our refined SCR score could improve detection of SCR for closer and noninvasive monitoring, allowing early treatment of SCR lesions notably for patients DSA-positive and during lowering of immunosuppressive treatment.
Collapse
Affiliation(s)
- Richard Danger
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France.
| | - Ludmilla Le Berre
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Marion Cadoux
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Clarisse Kerleau
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Emmanuelle Papuchon
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France; Centre d'Investigation Clinique en Biothérapie, Centre de Ressources Biologiques (CRB), CHU Nantes, Nantes, France
| | - Hoa Le Mai
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Thi-Van-Ha Nguyen
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Pierrick Guérif
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Emmanuel Morelon
- Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, INSERM Unit 1111, Lyon-Est Medical Faculty, Claude Bernard University (Lyon 1), Lyon, France
| | - Olivier Thaunat
- Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, INSERM Unit 1111, Lyon-Est Medical Faculty, Claude Bernard University (Lyon 1), Lyon, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Institute, INSERM, Paris University, Paris, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Institute, INSERM, Paris University, Paris, France
| | - Carmen Lefaucheur
- Paris Translational Research Center for Organ Transplantation, INSERM UMR S970, Université Paris Cité, Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis, and Apheresis, CHU Bordeaux, Bordeaux, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, Centre Hospitalier Universitaire de Toulouse, INSERM UMR1291 - Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Centre Hospitalier Universitaire de Toulouse, INSERM UMR1291 - Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Moglie Le Quintrec
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Lapeyronie, Montpellier, France
| | - Valentin Goutaudier
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Institute, INSERM, Paris University, Paris, France; Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Karine Renaudin
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France; CHU Nantes, Service d'Anatomie et Cytologie Pathologiques, Nantes, France
| | - Magali Giral
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France; Centre d'Investigation Clinique en Biothérapie, Centre de Ressources Biologiques (CRB), CHU Nantes, Nantes, France; LabEx IGO "Immunotherapy, Graft, Oncology", Nantes Université, Nantes, France
| | - Sophie Brouard
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France; Centre d'Investigation Clinique en Biothérapie, Centre de Ressources Biologiques (CRB), CHU Nantes, Nantes, France; LabEx IGO "Immunotherapy, Graft, Oncology", Nantes Université, Nantes, France.
| |
Collapse
|
18
|
Masset C, Kerleau C, Blancho G, Hourmant M, Walencik A, Ville S, Kervella D, Cantarovich D, Houzet A, Giral M, Garandeau C, Dantal J. Very Low Dose Anti-Thymocyte Globulins Versus Basiliximab in Non-Immunized Kidney Transplant Recipients. Transpl Int 2023; 36:10816. [PMID: 36819125 PMCID: PMC9935561 DOI: 10.3389/ti.2023.10816] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
The choice between Basiliximab (BSX) or Anti-Thymocyte Globulin (ATG) as induction therapy in non-immunized kidney transplant recipients remains uncertain. Whilst ATG may allow steroid withdrawal and a decrease in tacrolimus, it also increases infectious complications. We investigated outcomes in non-immunized patients receiving a very low dosage of ATG versus BSX as induction. Study outcomes were patient/graft survival, cumulative probabilities of biopsy proven acute rejection (BPAR), infectious episode including CMV and post-transplant diabetes (PTD). Cox, logistic or linear statistical models were used depending on the studied outcome and models were weighted on propensity scores. 100 patients received ATG (mean total dose of 2.0 mg/kg) and 83 received BSX. Maintenance therapy was comparable. Patient and graft survival did not differ between groups, nor did infectious complications. There was a trend for a higher occurrence of a first BPAR in the BSX group (HR at 1.92; 95%CI: [0.77; 4.78]; p = 0.15) with a significantly higher BPAR episodes (17% vs 7.3%, p = 0.01). PTD occurrence was significantly higher in the BSX group (HR at 2.44; 95%CI: [1.09; 5.46]; p = 0.03). Induction with a very low dose of ATG in non-immunized recipients was safe and associated with a lower rate of BPAR and PTD without increasing infectious complications.
Collapse
Affiliation(s)
- Christophe Masset
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie Clinique, CHU Nantes, Nantes, France.,INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes Université, Nantes, France
| | - Clarisse Kerleau
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie Clinique, CHU Nantes, Nantes, France
| | - Gilles Blancho
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie Clinique, CHU Nantes, Nantes, France.,INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes Université, Nantes, France
| | - Maryvonne Hourmant
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie Clinique, CHU Nantes, Nantes, France.,INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes Université, Nantes, France
| | | | - Simon Ville
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie Clinique, CHU Nantes, Nantes, France.,INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes Université, Nantes, France
| | - Delphine Kervella
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie Clinique, CHU Nantes, Nantes, France.,INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes Université, Nantes, France
| | - Diego Cantarovich
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie Clinique, CHU Nantes, Nantes, France
| | - Aurélie Houzet
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie Clinique, CHU Nantes, Nantes, France
| | - Magali Giral
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie Clinique, CHU Nantes, Nantes, France.,INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes Université, Nantes, France
| | - Claire Garandeau
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie Clinique, CHU Nantes, Nantes, France
| | - Jacques Dantal
- Institut de Transplantation Urologie Néphrologie (ITUN), Service de Néphrologie et Immunologie Clinique, CHU Nantes, Nantes, France.,INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes Université, Nantes, France
| | | |
Collapse
|
19
|
Mai HL, Degauque N, Lorent M, Rimbert M, Renaudin K, Danger R, Kerleau C, Tilly G, Vivet A, Le Bot S, Delbos F, Walencik A, Giral M, Brouard S. Kidney allograft rejection is associated with an imbalance of B cells, regulatory T cells and differentiated CD28-CD8+ T cells: analysis of a cohort of 1095 graft biopsies. Front Immunol 2023; 14:1151127. [PMID: 37168864 PMCID: PMC10164960 DOI: 10.3389/fimmu.2023.1151127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/25/2023] [Accepted: 04/06/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction The human immune system contains cells with either effector/memory or regulatory functions. Besides the well-established CD4+CD25hiCD127lo regulatory T cells (Tregs), we and others have shown that B cells can also have regulatory functions since their frequency and number are increased in kidney graft tolerance and B cell depletion as induction therapy may lead to acute rejection. On the other hand, we have shown that CD28-CD8+ T cells represent a subpopulation with potent effector/memory functions. In the current study, we tested the hypothesis that kidney allograft rejection may be linked to an imbalance of effector/memory and regulatory immune cells. Methods Based on a large cohort of more than 1000 kidney graft biopsies with concomitant peripheral blood lymphocyte phenotyping, we investigated the association between kidney graft rejection and the percentage and absolute number of circulating B cells, Tregs, as well as the ratio of B cells to CD28-CD8+ T cells and the ratio of CD28-CD8+ T cells to Tregs. Kidney graft biopsies were interpreted according to the Banff classification and divided into 5 biopsies groups: 1) normal/subnormal, 2) interstitial fibrosis and tubular atrophy grade 2/3 (IFTA), 3) antibody-mediated rejection (ABMR), 4) T cell mediated-rejection (TCMR), and 5) borderline rejection. We compared group 1 with the other groups as well as with a combined group 3, 4, and 5 (rejection of all types) using multivariable linear mixed models. Results and discussion We found that compared to normal/subnormal biopsies, rejection of all types was marginally associated with a decrease in the percentage of circulating B cells (p=0.06) and significantly associated with an increase in the ratio of CD28-CD8+ T cells to Tregs (p=0.01). Moreover, ABMR, TCMR (p=0.007), and rejection of all types (p=0.0003) were significantly associated with a decrease in the ratio of B cells to CD28-CD8+ T cells compared to normal/subnormal biopsies. Taken together, our results show that kidney allograft rejection is associated with an imbalance between immune cells with effector/memory functions and those with regulatory properties.
Collapse
Affiliation(s)
- Hoa Le Mai
- Centre Hospitalier Universitaire (CHU) Nantes, Nantes Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Center for Research in Transplantation and Translational Immunology, Unité mixte de recherche (UMR) 1064, Institut de Transplantation Urologie-Néphrologie (ITUN), Nantes, France
| | - Nicolas Degauque
- Centre Hospitalier Universitaire (CHU) Nantes, Nantes Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Center for Research in Transplantation and Translational Immunology, Unité mixte de recherche (UMR) 1064, Institut de Transplantation Urologie-Néphrologie (ITUN), Nantes, France
| | - Marine Lorent
- Centre Hospitalier Universitaire (CHU) Nantes, Nantes Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Center for Research in Transplantation and Translational Immunology, Unité mixte de recherche (UMR) 1064, Institut de Transplantation Urologie-Néphrologie (ITUN), Nantes, France
| | - Marie Rimbert
- Centre Hospitalier Universitaire (CHU) Nantes, Nantes Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Center for Research in Transplantation and Translational Immunology, Unité mixte de recherche (UMR) 1064, Institut de Transplantation Urologie-Néphrologie (ITUN), Nantes, France
- Laboratoire d’Immunologie, Centre d’ImmunoMonitorage Nantes-Atlantique (CIMNA), CHU Nantes, Nantes, France
| | - Karine Renaudin
- Centre Hospitalier Universitaire (CHU) Nantes, Nantes Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Center for Research in Transplantation and Translational Immunology, Unité mixte de recherche (UMR) 1064, Institut de Transplantation Urologie-Néphrologie (ITUN), Nantes, France
- Service d’Anatomie et Cytologie Pathologiques, CHU Nantes, Nantes, France
| | - Richard Danger
- Centre Hospitalier Universitaire (CHU) Nantes, Nantes Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Center for Research in Transplantation and Translational Immunology, Unité mixte de recherche (UMR) 1064, Institut de Transplantation Urologie-Néphrologie (ITUN), Nantes, France
| | - Clarisse Kerleau
- Centre Hospitalier Universitaire (CHU) Nantes, Nantes Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Center for Research in Transplantation and Translational Immunology, Unité mixte de recherche (UMR) 1064, Institut de Transplantation Urologie-Néphrologie (ITUN), Nantes, France
| | - Gaelle Tilly
- Centre Hospitalier Universitaire (CHU) Nantes, Nantes Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Center for Research in Transplantation and Translational Immunology, Unité mixte de recherche (UMR) 1064, Institut de Transplantation Urologie-Néphrologie (ITUN), Nantes, France
| | - Anaïs Vivet
- Centre Hospitalier Universitaire (CHU) Nantes, Nantes Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Center for Research in Transplantation and Translational Immunology, Unité mixte de recherche (UMR) 1064, Institut de Transplantation Urologie-Néphrologie (ITUN), Nantes, France
| | - Sabine Le Bot
- Centre Hospitalier Universitaire (CHU) Nantes, Nantes Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Center for Research in Transplantation and Translational Immunology, Unité mixte de recherche (UMR) 1064, Institut de Transplantation Urologie-Néphrologie (ITUN), Nantes, France
- Service de Néphrologie et Immunologie Clinique, CHU Nantes, Nantes, France
| | | | | | - Magali Giral
- Centre Hospitalier Universitaire (CHU) Nantes, Nantes Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Center for Research in Transplantation and Translational Immunology, Unité mixte de recherche (UMR) 1064, Institut de Transplantation Urologie-Néphrologie (ITUN), Nantes, France
- Service de Néphrologie et Immunologie Clinique, CHU Nantes, Nantes, France
- Fondation Centaure (RTRS), Nantes, France
- *Correspondence: Magali Giral, ; Sophie Brouard,
| | - Sophie Brouard
- Centre Hospitalier Universitaire (CHU) Nantes, Nantes Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Center for Research in Transplantation and Translational Immunology, Unité mixte de recherche (UMR) 1064, Institut de Transplantation Urologie-Néphrologie (ITUN), Nantes, France
- Fondation Centaure (RTRS), Nantes, France
- *Correspondence: Magali Giral, ; Sophie Brouard,
| |
Collapse
|
20
|
Masset C, Garandeau C, Houzet A, Kervella D, Ville S, Cantarovich D, Leclech A, Leman C, Gaisne R, Guillot-Gueguen C, Salomon O, Kerleau C, Giral M, Dantal J, Blancho G. COVID-19 Severity in Kidney Transplant Recipients According to Their Postvaccination Serological Assessment. Kidney Int Rep 2023; 8:183-187. [PMID: 36249993 PMCID: PMC9550278 DOI: 10.1016/j.ekir.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/20/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Christophe Masset
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France,Center for Research in Transplantation and Translational Immunology,Nantes Université, INSERM, UMR 1064, Nantes, France,Correspondence: Christophe Masset, 30 bd Jean Monnet, 44093 Nantes Cedex 01, France
| | - Claire Garandeau
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Aurélie Houzet
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Delphine Kervella
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France,Center for Research in Transplantation and Translational Immunology,Nantes Université, INSERM, UMR 1064, Nantes, France
| | - Simon Ville
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France,Center for Research in Transplantation and Translational Immunology,Nantes Université, INSERM, UMR 1064, Nantes, France
| | - Diego Cantarovich
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Alice Leclech
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Claire Leman
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Raphael Gaisne
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | | | - Océane Salomon
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Clarisse Kerleau
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France,Center for Research in Transplantation and Translational Immunology,Nantes Université, INSERM, UMR 1064, Nantes, France
| | - Magali Giral
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France,Center for Research in Transplantation and Translational Immunology,Nantes Université, INSERM, UMR 1064, Nantes, France
| | - Jacques Dantal
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France,Center for Research in Transplantation and Translational Immunology,Nantes Université, INSERM, UMR 1064, Nantes, France
| | - Gilles Blancho
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France,Center for Research in Transplantation and Translational Immunology,Nantes Université, INSERM, UMR 1064, Nantes, France
| | | |
Collapse
|
21
|
Girardin FR, Nicolet A, Bestard O, Lefaucheur C, Budde K, Halleck F, Brouard S, Giral M, Gourraud PA, Horcholle B, Villard J, Marti J, Loupy A. Immunosuppressant drugs and quality-of-life outcomes in kidney transplant recipients: An international cohort study (EU-TRAIN). Front Pharmacol 2023; 14:1040584. [PMID: 37180729 PMCID: PMC10174308 DOI: 10.3389/fphar.2023.1040584] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/31/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction: Patient-Reported Outcomes (PRO) integrate a wide range of holistic dimensions that arenot captured within clinical outcomes. Particularly, from induction treatment to maintenance therapy, patient quality-of-life (QoL) of kidney transplant recipients have been sparsely investigated in international settings. Methods: In a prospective, multi-centric cohort study, including nine transplant centers in four countries, we explored the QoL during the year following transplantation using validated elicitation instruments (EQ-5D-3L index with VAS) in a population of kidney transplant patients receiving immunosuppressive therapies. Calcineurin inhibitors (tacrolimus and ciclosporin), IMPD inhibitor (mycophenolate mofetil), and mTOR inhibitors (everolimus and sirolimus) were the standard-of-care (SOC) medications, together with tapering glucocorticoid therapy. We used EQ-5D and VAS data as QoL measures alongside descriptive statistics at inclusion, per country and hospital center. We computed the proportions of patients with different immunosuppressive therapy patterns, and using bivariate and multivariate analyses, assessed the variations of EQ-5D and VAS between baseline (i.e., inclusion Month 0) and follow up visits (Month 12). Results: Among 542 kidney transplant patients included and followed from November 2018 to June 2021, 491 filled at least one QoL questionnaire at least at baseline (Month 0). The majority of patients in all countries received tacrolimus and mycophenolate mofetil, ranging from 90.0% in Switzerland and Spain to 95.8% in Germany. At M12, a significant proportion of patients switched immunosuppressive drugs, with proportion varying from 20% in Germany to 40% in Spain and Switzerland. At visit M12, patients who kept SOC therapy had higher EQ-5D (by 8 percentage points, p < 0.05) and VAS (by 4 percentage points, p < 0.1) scores than switchers. VAS scores were generally lower than EQ-5D (mean 0.68 [0.5-0.8] vs. 0.85 [0.8-1]). Discussion: Although overall a positive trend in QoL was observed, the formal analyses did not show any significant improvements in EQ-5D scores or VAS. Only when the effect of a therapy use was separated from the effect of switching, the VAS score was significantly worse for switchers during the follow up period, irrespective of the therapy type. If adjusted for patient characteristics and medical history (e.g., gender, BMI, eGRF, history of diabetes), VAS and EQ-5D delivered sound PRO measures for QoL assessments during the year following renal transplantation.
Collapse
Affiliation(s)
- François R. Girardin
- Division of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital, Faculty of Medicine, University of Lausanne, Lausanne, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
- *Correspondence: François R. Girardin, ; Anna Nicolet,
| | - Anna Nicolet
- Center for Primary Care and Public Health (UniSanté), University of Lausanne, Lausanne, Switzerland
- *Correspondence: François R. Girardin, ; Anna Nicolet,
| | - Oriol Bestard
- Department of Nephrology and Kidney Transplantation, Vall d’Hebron Hospital Universitari, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carmen Lefaucheur
- Kidney Transplant Department, Saint Louis Hospital, Unité de Recherche Clinique, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale UMR-S970, Université de Paris, Paris, France
| | - Klemens Budde
- Department of Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Fabian Halleck
- Department of Nephrology and Intensive Care, Charité Virchow Clinic, University Hospital, Berlin, Germany
| | - Sophie Brouard
- Nantes Université, INSERM, CRT2I—Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Magali Giral
- Nantes Université, INSERM, CRT2I—Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Pierre-Antoine Gourraud
- Nantes Université, INSERM, CRT2I—Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Béatrice Horcholle
- Kidney Transplant Department, Saint Louis Hospital, Unité de Recherche Clinique, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean Villard
- Transplantation Immunology Unit, National Reference Laboratory for Histocompatibility, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Joachim Marti
- Center for Primary Care and Public Health (UniSanté), University of Lausanne, Lausanne, Switzerland
| | - 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
- Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| |
Collapse
|
22
|
Rousselière A, Gérard N, Delbos L, Guérif P, Giral M, Bressollette-Bodin C, Charreau B. Distinctive phenotype for HLA-E- versus HLA-A2-restricted memory CD8 αβT cells in the course of HCMV infection discloses features shared with NKG2C +CD57 +NK and δ2 -γδT cell subsets. Front Immunol 2022; 13:1063690. [PMID: 36532017 PMCID: PMC9752567 DOI: 10.3389/fimmu.2022.1063690] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/10/2022] [Indexed: 12/04/2022] Open
Abstract
The human cytomegalovirus (HCMV) triggers both innate and adaptive immune responses, including protective CD8+ αβT cells (CD8T) that contributes to the control of the infection. In addition to CD8T restricted by classical HLA class Ia molecules, HCMV also triggers CD8T recognizing peptides from the HCMV UL40 leader peptide and restricted by HLA-E molecules (HLA-EUL40 CD8T). This study investigated the frequency, phenotype and functions of HLA-EUL40 CD8T in comparison to the immunodominant HLA-A2pp65 CD8T upon acute (primary or secondary infection) or chronic infection in kidney transplant recipients (KTR) and in seropositive (HCMV+) healthy volunteer (HV) hosts. The frequency of hosts with detected HLA-EUL40 CD8T was similar after a primary infection (24%) and during viral latency in HCMV+ HV (26%) and equal to the frequency of HLA-A2pp65 CD8T cells in both conditions (29%). Both CD8T subsets vary from 0.1% to >30% of total circulating CD8T according to the host. Both HLA-EUL40 and HLA-A2pp65 CD8T display a phenotype specific of CD8+ TEMRA (CD45RA+/CCR7-) but HLA-EUL40 CD8T express distinctive level for CD3, CD8 and CD45RA. Tim3, Lag-3, 4-1BB, and to a lesser extend 2B4 are hallmarks for T cell priming post-primary infection while KLRG1 and Tigit are markers for restimulated and long lived HCMV-specific CD8T responses. These cell markers are equally expressed on HLA-EUL40 and HLA-A2pp65 CD8T. In contrast, CD56 and PD-1 are cell markers discriminating memory HLA-E- from HLA-A2-restricted CD8T. Long lived HLA-EUL40 display higher proliferation rate compared to HLA-A2pp65 CD8T consistent with elevated CD57 expression. Finally, a comparative immunoprofiling indicated that HLA-EUL40 CD8T, divergent from HLA-A2pp65 CD8T, share the expression of CD56, CD57, NKG2C, CD158 and the lack of PD-1 with NKG2C+CD57+ NK and δ2-γδT cells induced in response to HCMV and thus defines a common immunopattern for these subsets.
Collapse
Affiliation(s)
- Amélie Rousselière
- Nantes Université, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, Nantes, France
| | - Nathalie Gérard
- Nantes Université, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, Nantes, France
| | - Laurence Delbos
- Nantes Université, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, Nantes, France
| | - Pierrick Guérif
- CHU Nantes, Nantes Université, Institut de Transplantation Urologie Néphrologie (ITUN), Nantes, France
| | - Magali Giral
- Nantes Université, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, Nantes, France,CHU Nantes, Nantes Université, Institut de Transplantation Urologie Néphrologie (ITUN), Nantes, France
| | - Céline Bressollette-Bodin
- Nantes Université, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, Nantes, France,CHU Nantes, Nantes Université, Laboratoire de Virologie, Nantes, France
| | - Béatrice Charreau
- Nantes Université, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, UMR 1064, Nantes, France,CHU Nantes, Nantes Université, Institut de Transplantation Urologie Néphrologie (ITUN), Nantes, France,*Correspondence: Béatrice Charreau,
| |
Collapse
|
23
|
Doan Ngoc TM, Tilly G, Danger R, Bonizec O, Masset C, Guérif P, Bruneau S, Glemain A, Harb J, Cadoux M, Vivet A, Mai HL, Garcia A, Laplaud D, Liblau R, Giral M, Blandin S, Feyeux M, Dubreuil L, Pecqueur C, Cyr M, Ni W, Brouard S, Degauque N. Effector Memory-Expressing CD45RA (TEMRA) CD8 + T Cells from Kidney Transplant Recipients Exhibit Enhanced Purinergic P2X4 Receptor-Dependent Proinflammatory and Migratory Responses. J Am Soc Nephrol 2022; 33:2211-2231. [PMID: 36280286 PMCID: PMC9731633 DOI: 10.1681/asn.2022030286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/22/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The mechanisms regulating CD8+ T cell migration to nonlymphoid tissue during inflammation have not been fully elucidated, and the migratory properties of effector memory CD8+ T cells that re-express CD45RA (TEMRA CD8+ T cells) remain unclear, despite their roles in autoimmune diseases and allotransplant rejection. METHODS We used single-cell proteomic profiling and functional testing of CD8+ T cell subsets to characterize their effector functions and migratory properties in healthy volunteers and kidney transplant recipients with stable or humoral rejection. RESULTS We showed that humoral rejection of a kidney allograft is associated with an accumulation of cytolytic TEMRA CD8+ T cells in blood and kidney graft biopsies. TEMRA CD8+ T cells from kidney transplant recipients exhibited enhanced migratory properties compared with effector memory (EM) CD8+ T cells, with enhanced adhesion to activated endothelium and transmigration in response to the chemokine CXCL12. CXCL12 directly triggers a purinergic P2×4 receptor-dependent proinflammatory response of TEMRA CD8+ T cells from transplant recipients. The stimulation with IL-15 promotes the CXCL12-induced migration of TEMRA and EM CD8+ T cells and promotes the generation of functional PSGL1, which interacts with the cell adhesion molecule P-selectin and adhesion of these cells to activated endothelium. Although disruption of the interaction between functional PSGL1 and P-selectin prevents the adhesion and transmigration of both TEMRA and EM CD8+ T cells, targeting VLA-4 or LFA-1 (integrins involved in T cell migration) specifically inhibited the migration of TEMRA CD8+ T cells from kidney transplant recipients. CONCLUSIONS Our findings highlight the active role of TEMRA CD8+ T cells in humoral transplant rejection and suggest that kidney transplant recipients may benefit from therapeutics targeting these cells.
Collapse
Affiliation(s)
- Tra-My Doan Ngoc
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Gaëlle Tilly
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Richard Danger
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
- CHU Nantes, Nantes Université, Institut de Transplantation Urologie Néphrologie, Nantes, France
| | - Orianne Bonizec
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Christophe Masset
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
- CHU Nantes, Nantes Université, Institut de Transplantation Urologie Néphrologie, Nantes, France
| | - Pierrick Guérif
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
- CHU Nantes, Nantes Université, Institut de Transplantation Urologie Néphrologie, Nantes, France
| | - Sarah Bruneau
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Alexandre Glemain
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Jean Harb
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
- CHU Nantes, Nantes Université, Institut de Transplantation Urologie Néphrologie, Nantes, France
| | - Marion Cadoux
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Anaïs Vivet
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Hoa Le Mai
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
- CHU Nantes, Nantes Université, Institut de Transplantation Urologie Néphrologie, Nantes, France
| | - Alexandra Garcia
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - David Laplaud
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Roland Liblau
- CNRS, Institut National de la Santé et de la Recherche Médicale, UPS, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, Toulouse, France
- Department of Immunology, Toulouse University Hospital, Toulouse, France
| | - Magali Giral
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
- CHU Nantes, Nantes Université, Institut de Transplantation Urologie Néphrologie, Nantes, France
| | - Stéphanie Blandin
- CHU Nantes, CNRS, Institut National de la Santé et de la Recherche Médicale, BioCore, US16, SFR Bonamy, Nantes Université, Nantes, France
| | - Magalie Feyeux
- CHU Nantes, CNRS, Institut National de la Santé et de la Recherche Médicale, BioCore, US16, SFR Bonamy, Nantes Université, Nantes, France
| | | | - Claire Pecqueur
- Université d’Angers, Institut National de la Santé et de la Recherche Médicale, CNRS, CRCI2NA, Nantes Université, Nantes, France
| | - Matthew Cyr
- IsoPlexis Corporation, Branford, Connecticut
| | - Weiming Ni
- IsoPlexis Corporation, Branford, Connecticut
| | - Sophie Brouard
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
- CHU Nantes, Nantes Université, Institut de Transplantation Urologie Néphrologie, Nantes, France
| | - Nicolas Degauque
- Institut National de la Santé et de la Recherche Médicale, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| |
Collapse
|
24
|
Masset C, Dantal J, Soulillou JP, Walencik A, Delbos F, Brouard S, Giral M. Case Report: Long-term observations from the tacrolimus weaning randomized clinical trial depicts the challenging aspects for determination of low-immunological risk patients. Front Immunol 2022; 13:1021481. [PMID: 36518770 PMCID: PMC9744190 DOI: 10.3389/fimmu.2022.1021481] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/31/2022] [Indexed: 11/30/2022] Open
Abstract
Whilst calcineurin inhibitors (CNI) are the cornerstone of immunosuppressive maintenance therapy in kidney transplantation, several studies have investigated the safety of CNI withdrawal in order to avoid their numerous side effects. In this context, we performed several years ago a clinical randomized trial evaluating CNI weaning in stable kidney transplant recipients without anti-HLA immunization. The trial was interrupted prematurely due to a high number of de novo DSA (dnDSA) and biopsy proven acute rejection (BPAR) in patients who underwent tacrolimus weaning, resulting in treatment for rejection and resumption of tacrolimus. We report here the long-term outcomes of patients included in this clinical trial. Ten years after randomization, all patients are alive with a functional allograft. They all receive tacrolimus therapy except one with recurrent cutaneous neoplasia issues. Long-term eGFR was comparable between patients of the two randomized groups (46.4 ml/min vs 42.8 ml/min). All dnDSA that occurred during the study period became non-detectable and all rejections episodes were reversed. The retrospective assessment of HLA DQ single molecule epitope mismatching determined that a majority of patients who developed dnDSA after tacrolimus withdrawal would have been considered at high immunological risk. Minimization of immunosuppression remains a challenging objective, mainly because of the issues to properly select very low immunological risk patients. Valuable improvements have been made the last decade regarding evaluation of the allograft rejection notably through the determination of numerous at-risk biomarkers. However, even if the impact of such tools still need to be clarify in clinical routine, they may permit an improvement in patients' selection for immunosuppression minimization without increasing the risk of allograft rejection.
Collapse
Affiliation(s)
- Christophe Masset
- Institut de Transplantation Urologie Néphrologie (ITUN), Centre Hospitalo-Universitaire (CHU) Nantes, Nantes, France,Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Jacques Dantal
- Institut de Transplantation Urologie Néphrologie (ITUN), Centre Hospitalo-Universitaire (CHU) Nantes, Nantes, France,Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Jean-Paul Soulillou
- Institut de Transplantation Urologie Néphrologie (ITUN), Centre Hospitalo-Universitaire (CHU) Nantes, Nantes, France,Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Alexandre Walencik
- Laboratoire d’immunologie et HLA Etablissement Français du Sang, Nantes, France
| | - Florent Delbos
- Laboratoire d’immunologie et HLA Etablissement Français du Sang, Nantes, France
| | - Sophie Brouard
- Institut de Transplantation Urologie Néphrologie (ITUN), Centre Hospitalo-Universitaire (CHU) Nantes, Nantes, France,Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France,*Correspondence: Magali Giral, ; Sophie Brouard,
| | - Magali Giral
- Institut de Transplantation Urologie Néphrologie (ITUN), Centre Hospitalo-Universitaire (CHU) Nantes, Nantes, France,Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France,*Correspondence: Magali Giral, ; Sophie Brouard,
| | | |
Collapse
|
25
|
Meneghini M, Perona A, Crespo E, Bemelman F, Reinke P, Viklicky O, Giral M, Palou E, Torija A, Donadeu L, Melilli E, Zuñiga J, Sefrin A, Lachmann N, Hu L, Hruba P, Guillot-Gueguen C, Brouard S, Grinyo J, Bestard O. On the clinical relevance of using complete high-resolution HLA typing for an accurate interpretation of posttransplant immune-mediated graft outcomes. Front Immunol 2022; 13:924825. [PMID: 36248818 PMCID: PMC9559221 DOI: 10.3389/fimmu.2022.924825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/30/2022] [Indexed: 11/18/2022] Open
Abstract
Complete and high-resolution (HR) HLA typing improves the accurate assessment of donor–recipient compatibility and pre-transplant donor-specific antibodies (DSA). However, the value of this information to identify de novo immune-mediated graft events and its impact on outcomes has not been assessed. In 241 donor/recipient kidney transplant pairs, DNA samples were re-evaluated for six-locus (A/B/C/DRB1/DQB1+A1/DPB1) HR HLA typing. De novo anti-HLA antibodies were assessed using solid-phase assays, and dnDSA were classified either (1) as per current clinical practice according to three-locus (A/B/DRB1) low-resolution (LR) typing, estimating donor HLA-C/DQ typing with frequency tables, or (2) according to complete six-locus HR typing. The impact on graft outcomes was compared between groups. According to LR HLA typing, 36 (15%) patients developed dnDSA (LR_dnDSA+). Twenty-nine out of 36 (80%) were confirmed to have dnDSA by HR typing (LR_dnDSA+/HR_dnDSA+), whereas 7 (20%) did not (LR_dnDSA+/HR_dnDSA−). Out of 49 LR_dnDSA specificities, 34 (69%) were confirmed by HR typing whereas 15 (31%) LR specificities were not confirmed. LR_dnDSA+/HR_dnDSA+ patients were at higher risk of ABMR as compared to dnDSA− and LR_dnDSA+/HR_dnDSA− (logRank < 0.001), and higher risk of death-censored graft loss (logRank = 0.001). Both LR_dnDSA+ (HR: 3.51, 95% CI = 1.25–9.85) and LR_dnDSA+/HR_dnDSA+ (HR: 4.09, 95% CI = 1.45–11.54), but not LR_dnDSA+/HR_dnDSA− independently predicted graft loss. The implementation of HR HLA typing improves the characterization of biologically relevant de novo anti-HLA DSA and discriminates patients with poorer graft outcomes.
Collapse
Affiliation(s)
- Maria Meneghini
- Kidney Transplant Unit, Nephrology Department. Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Perona
- Department of Medicine, Barcelona University, Barcelona, Spain
| | - Elena Crespo
- Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Frederike Bemelman
- Renal Transplant Unit, Department of Internal Medicine, Amsterdam University Medical Centers, Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands
| | - Petra Reinke
- Berlin Center for Advanced Therapies (BeCAT), Berlin Institute of Health Center for Regenerative Therapies (BCRT) and Department of Nephrology and Intensive Care, Charité Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ondrej Viklicky
- Transplant Laboratory, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
- Department of Nephrology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Magali Giral
- Nantes Université, Inserm, Centre Hospitalier Universitaire (CHU) Nantes, Centre de Recherche en Transplantation et Immunologie UMR1064, Institut de Transplantation Urologie-Néphrologie (ITUN), Nantes, France
| | - Eduard Palou
- Histocompatibility Laboratory, Immunology Department. Hospital Clinic, Barcelona, Spain
| | - Alba Torija
- Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Donadeu
- Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Melilli
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Jose Zuñiga
- Kidney Transplant Unit, Nephrology Department. Vall d’Hebron University Hospital, Barcelona, Spain
| | - Anett Sefrin
- Berlin Center for Advanced Therapies (BeCAT), Berlin Institute of Health Center for Regenerative Therapies (BCRT) and Department of Nephrology and Intensive Care, Charité Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany
| | - Nils Lachmann
- HLA- Laboratory, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Liu Hu
- Renal Transplant Unit, Department of Internal Medicine, Amsterdam University Medical Centers, Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands
| | - Petra Hruba
- Transplant Laboratory, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
- Department of Nephrology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Cécile Guillot-Gueguen
- Nantes Université, Inserm, Centre Hospitalier Universitaire (CHU) Nantes, Centre de Recherche en Transplantation et Immunologie UMR1064, Institut de Transplantation Urologie-Néphrologie (ITUN), Nantes, France
| | - Sophie Brouard
- Nantes Université, Inserm, Centre Hospitalier Universitaire (CHU) Nantes, Centre de Recherche en Transplantation et Immunologie UMR1064, Institut de Transplantation Urologie-Néphrologie (ITUN), Nantes, France
| | - Josep Grinyo
- Department of Medicine, Barcelona University, Barcelona, Spain
| | - Oriol Bestard
- Kidney Transplant Unit, Nephrology Department. Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- *Correspondence: Oriol Bestard,
| |
Collapse
|
26
|
Freuchet A, Salama A, Bézie S, Tesson L, Rémy S, Humeau R, Règue H, Sérazin C, Flippe L, Peterson P, Vimond N, Usal C, Ménoret S, Heslan JM, Duteille F, Blanchard F, Giral M, Colonna M, Anegon I, Guillonneau C. IL-34 deficiency impairs FOXP3 + Treg function in a model of autoimmune colitis and decreases immune tolerance homeostasis. Clin Transl Med 2022; 12:e988. [PMID: 36030499 PMCID: PMC9420423 DOI: 10.1002/ctm2.988] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 12/19/2022] Open
Abstract
Background Immune homeostasis requires fully functional Tregs with a stable phenotype to control autoimmunity. Although IL‐34 is a cytokine first described as mainly involved in monocyte cell survival and differentiation, we recently described its expression by CD8+ Tregs in a rat model of transplantation tolerance and by activated FOXP3+ CD4+ and CD8+ Tregs in human healthy individuals. However, its role in autoimmunity and potential in human diseases remains to be determined. Methods We generated Il34−/− rats and using both Il34−/− rats and mice, we investigated their phenotype under inflammatory conditions. Using Il34−/− rats, we further analyzed the impact of the absence of expression of IL‐34 for CD4+ Tregs suppressive function. We investigated the potential of IL‐34 in human disease to prevent xenogeneic GVHD and human skin allograft rejection in immune humanized immunodeficient NSG mice. Finally, taking advantage of a biocollection, we investigated the correlation between presence of IL‐34 in the serum and kidney transplant rejection. Results Here we report that the absence of expression of IL‐34 in Il34−/− rats and mice leads to an unstable immune phenotype, with production of multiple auto‐antibodies, exacerbated under inflammatory conditions with increased susceptibility to DSS‐ and TNBS‐colitis in Il34−/− animals. Moreover, we revealed the striking inability of Il34−/− CD4+ Tregs to protect Il2rg−/− rats from a wasting disease induced by transfer of pathogenic cells, in contrast to Il34+/+ CD4+ Tregs. We also showed that IL‐34 treatment delayed EAE in mice as well as GVHD and human skin allograft rejection in immune humanized immunodeficient NSG mice. Finally, we show that presence of IL‐34 in the serum is associated with a longer rejection‐free period in kidney transplanted patients. Conclusion Altogether, our data emphasize on the crucial necessity of IL‐34 for immune homeostasis and for CD4+ Tregs suppressive function. Our data also shows the therapeutic potential of IL‐34 in human transplantation and auto‐immunity. Highlights Absence of expression of IL‐34 in Il34−/− rats and mice leads to an unstable immune phenotype, with a production of multiple auto‐antibodies and exacerbated immune pathology under inflammatory conditions. Il34−/− CD4+ Tregs are unable to protect Il2rg−/− rats from colitis induced by transfer of pathogenic cells. IL‐34 treatment delayed EAE in mice, as well as acute GVHD and human skin allograft rejection in immune‐humanized immunodeficient NSG mice.
Collapse
Affiliation(s)
- Antoine Freuchet
- Nantes Université, CHU Nantes, CNRS, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, F-44000, France
| | - Apolline Salama
- Nantes Université, CHU Nantes, CNRS, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, F-44000, France
| | - Séverine Bézie
- Nantes Université, CHU Nantes, CNRS, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, F-44000, France
| | - Laurent Tesson
- Nantes Université, CHU Nantes, CNRS, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, F-44000, France
| | - Séverine Rémy
- Nantes Université, CHU Nantes, CNRS, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, F-44000, France
| | - Romain Humeau
- Nantes Université, CHU Nantes, CNRS, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, F-44000, France
| | - Hadrien Règue
- Nantes Université, CHU Nantes, CNRS, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, F-44000, France
| | - Céline Sérazin
- Nantes Université, CHU Nantes, CNRS, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, F-44000, France
| | - Léa Flippe
- Nantes Université, CHU Nantes, CNRS, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, F-44000, France
| | - Pärt Peterson
- Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Nadège Vimond
- Nantes Université, CHU Nantes, CNRS, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, F-44000, France
| | - Claire Usal
- Nantes Université, CHU Nantes, CNRS, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, F-44000, France
| | - Séverine Ménoret
- Nantes Université, CHU Nantes, CNRS, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, F-44000, France.,CHU Nantes, Inserm, CNRS, SFR Santé, Inserm UMS 016, CNRS UMS 3556, Nantes Université, Nantes, France
| | - Jean-Marie Heslan
- Nantes Université, CHU Nantes, CNRS, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, F-44000, France
| | - Franck Duteille
- Chirurgie Plastique Reconstructrice et Esthétique, CHU Nantes, Nantes, France
| | - Frédéric Blanchard
- INSERM UMR1238, Bone Sarcoma and remodeling of calcified tissues, Nantes University, Nantes, France
| | - Magali Giral
- Nantes Université, CHU Nantes, CNRS, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, F-44000, France
| | - Marco Colonna
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ignacio Anegon
- Nantes Université, CHU Nantes, CNRS, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, F-44000, France
| | - Carole Guillonneau
- Nantes Université, CHU Nantes, CNRS, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, F-44000, France
| |
Collapse
|
27
|
Pacaud M, Colas L, Kerleau C, Le Borgne F, Giral M, Brouard S, Dantal J. Impact of Late and Recurrent Acute Graft Pyelonephritis on Long-Term Kidney Graft Outcomes. Front Immunol 2022; 13:824425. [PMID: 35418982 PMCID: PMC8998071 DOI: 10.3389/fimmu.2022.824425] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background While Urinary tract infections are the most common infections in kidney transplant recipients, the impact of late acute graft pyelonephritis (AGPN) on graft outcomes remains unknown. Our study was performed to more precisely evaluate the long-term impact of AGPN. Methods We included 9052 kidney and combined kidney-pancreas recipients who underwent transplantation between 2008 and 2018 from a French multicenter cohort. The relationships between AGPN and patient and graft survival were analyzed with a time-dependent multivariate Cox model. Results The cumulative incidence of AGPN was 20.9%. A first episode of early AGPN is associated with a non-significant increase in the risk of graft failure (hazard ratio [HR], 1.27; 95% confidence interval [95% CI], 0.90 to 1.79). Though, cumulative number of AGPN episodes (HR = 1.51; 95% CI, 0.89 to 2.57 for two episodes and HR = 2.08; 95% CI, 1.17 to 3.69 for three or more episodes) is associated with an increased risk of graft failure. In contrast, when the first episode of AGPN occurred late (i.e., 6 months post transplantation), the risk of graft failure is significantly increased (HR = 2.25; 95% CI, 1.65 to 3.07), and this risk remains relatively stable with the recurrence of late AGPN episodes. The onset of late AGPN were also associated with a higher risk of patient death. Conclusion This analysis shows that late AGPN and recurrent AGPN are both risk factors for a poor long-term graft outcome and mortality. Late AGPN should not be considered benign infections in post-transplantation follow-up.
Collapse
Affiliation(s)
- Margaux Pacaud
- INSERM, CHU Nantes, Nantes Université, Centre de Recherche en Transplantation et Immunologie UMR1064, ITUN, Nantes, France
| | - Luc Colas
- INSERM, CHU Nantes, Nantes Université, Centre de Recherche en Transplantation et Immunologie UMR1064, ITUN, Nantes, France
| | - Clarisse Kerleau
- CHU Nantes, Nantes Université, Service de néphrologie - immunologie clinique, Nantes, France
| | - Florent Le Borgne
- Université de Tours, INSERM UMR 1246-SPHERE, Nantes, France.,IDBC-A2COM, Pacé, France
| | - Magali Giral
- INSERM, CHU Nantes, Nantes Université, Centre de Recherche en Transplantation et Immunologie UMR1064, ITUN, Nantes, France.,CHU Nantes, Nantes Université, Service de néphrologie - immunologie clinique, Nantes, France.,Labex IGO, Nantes, France.,Centre d'Investigation Clinique en Biothérapie, Centre de ressources biologiques (CRB), Nantes, France
| | - Sophie Brouard
- INSERM, CHU Nantes, Nantes Université, Centre de Recherche en Transplantation et Immunologie UMR1064, ITUN, Nantes, France.,CHU Nantes, Nantes Université, Service de néphrologie - immunologie clinique, Nantes, France.,Labex IGO, Nantes, France.,Centre d'Investigation Clinique en Biothérapie, Centre de ressources biologiques (CRB), Nantes, France
| | - Jacques Dantal
- INSERM, CHU Nantes, Nantes Université, Centre de Recherche en Transplantation et Immunologie UMR1064, ITUN, Nantes, France.,CHU Nantes, Nantes Université, Service de néphrologie - immunologie clinique, Nantes, France.,Labex IGO, Nantes, France.,Centre d'Investigation Clinique en Biothérapie, Centre de ressources biologiques (CRB), Nantes, France
| |
Collapse
|
28
|
Masset C, Benotmane I, Dantal J, Garandeau C, Gauthier-Vargas G, Cantarovich D, Meurette A, Giral M, Caillard S, Blancho G. A fourth SARS-CoV-2 mRNA vaccine in strictly seronegative kidney transplant recipients. Kidney Int 2022; 101:825-826. [PMID: 35167873 PMCID: PMC8839796 DOI: 10.1016/j.kint.2022.01.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/20/2022] [Accepted: 01/27/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Christophe Masset
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie, Centre Hospitalo-Universitaire Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France.
| | - Ilies Benotmane
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Strasbourg, France
| | - Jacques Dantal
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie, Centre Hospitalo-Universitaire Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Claire Garandeau
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie, Centre Hospitalo-Universitaire Nantes, Nantes, France
| | | | - Diego Cantarovich
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie, Centre Hospitalo-Universitaire Nantes, Nantes, France
| | - Aurélie Meurette
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie, Centre Hospitalo-Universitaire Nantes, Nantes, France
| | - Magali Giral
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie, Centre Hospitalo-Universitaire Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Sophie Caillard
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Strasbourg, France
| | - Gilles Blancho
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie, Centre Hospitalo-Universitaire Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
| |
Collapse
|
29
|
Carapito R, Aouadi I, Verniquet M, Untrau M, Pichot A, Beaudrey T, Bassand X, Meyer S, Faucher L, Posson J, Morlon A, Kotova I, Delbos F, Walencik A, Aarnink A, Kennel A, Suberbielle C, Taupin JL, Matern BM, Spierings E, Congy-Jolivet N, Essaydi A, Perrin P, Blancher A, Charron D, Cereb N, Maumy-Bertrand M, Bertrand F, Garrigue V, Pernin V, Weekers L, Naesens M, Kamar N, Legendre C, Glotz D, Caillard S, Ladrière M, Giral M, Anglicheau D, Süsal C, Bahram S. The MHC class I MICA gene is a histocompatibility antigen in kidney transplantation. Nat Med 2022; 28:989-998. [PMID: 35288692 PMCID: PMC9117142 DOI: 10.1038/s41591-022-01725-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 01/31/2022] [Indexed: 01/10/2023]
Abstract
The identity of histocompatibility loci, besides human leukocyte antigen (HLA), remains elusive. The major histocompatibility complex (MHC) class I MICA gene is a candidate histocompatibility locus. Here, we investigate its role in a French multicenter cohort of 1,356 kidney transplants. MICA mismatches were associated with decreased graft survival (hazard ratio (HR), 2.12; 95% confidence interval (CI): 1.45–3.11; P < 0.001). Both before and after transplantation anti-MICA donor-specific antibodies (DSA) were strongly associated with increased antibody-mediated rejection (ABMR) (HR, 3.79; 95% CI: 1.94–7.39; P < 0.001; HR, 9.92; 95% CI: 7.43–13.20; P < 0.001, respectively). This effect was synergetic with that of anti-HLA DSA before and after transplantation (HR, 25.68; 95% CI: 3.31–199.41; P = 0.002; HR, 82.67; 95% CI: 33.67–202.97; P < 0.001, respectively). De novo-developed anti-MICA DSA were the most harmful because they were also associated with reduced graft survival (HR, 1.29; 95% CI: 1.05–1.58; P = 0.014). Finally, the damaging effect of anti-MICA DSA on graft survival was confirmed in an independent cohort of 168 patients with ABMR (HR, 1.71; 95% CI: 1.02–2.86; P = 0.041). In conclusion, assessment of MICA matching and immunization for the identification of patients at high risk for transplant rejection and loss is warranted. Analysis of a multicenter cohort of kidney transplants shows that mismatches in the MICA locus and the presence of anti-MICA donor-specific antibodies are associated with reduced graft survival and increased rejection.
Collapse
Affiliation(s)
- Raphael Carapito
- Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Centre de Recherche d'Immunologie et d'Hématologie, Centre de Recherche en Biomédecine de Strasbourg (CRBS), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France. .,Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France. .,Institut National de la Santé et de la Recherche Médicale (INSERM) Franco (Strasbourg)-Japanese (Nagano) Nextgen HLA Laboratory, Strasbourg, France. .,Laboratoire d'Immunologie, Plateau Technique de Biologie, Pôle de Biologie, Nouvel Hôpital Civil, Strasbourg, France. .,Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Strasbourg, France.
| | - Ismail Aouadi
- Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Centre de Recherche d'Immunologie et d'Hématologie, Centre de Recherche en Biomédecine de Strasbourg (CRBS), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Franco (Strasbourg)-Japanese (Nagano) Nextgen HLA Laboratory, Strasbourg, France.,Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Strasbourg, France
| | - Martin Verniquet
- Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Centre de Recherche d'Immunologie et d'Hématologie, Centre de Recherche en Biomédecine de Strasbourg (CRBS), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Franco (Strasbourg)-Japanese (Nagano) Nextgen HLA Laboratory, Strasbourg, France.,Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Strasbourg, France
| | - Meiggie Untrau
- Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Centre de Recherche d'Immunologie et d'Hématologie, Centre de Recherche en Biomédecine de Strasbourg (CRBS), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Franco (Strasbourg)-Japanese (Nagano) Nextgen HLA Laboratory, Strasbourg, France.,Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Strasbourg, France
| | - Angélique Pichot
- Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Centre de Recherche d'Immunologie et d'Hématologie, Centre de Recherche en Biomédecine de Strasbourg (CRBS), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Franco (Strasbourg)-Japanese (Nagano) Nextgen HLA Laboratory, Strasbourg, France.,Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Strasbourg, France
| | - Thomas Beaudrey
- Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Centre de Recherche d'Immunologie et d'Hématologie, Centre de Recherche en Biomédecine de Strasbourg (CRBS), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Strasbourg, France.,Nephrology-Transplantation Department, University Hospital, Strasbourg, France
| | - Xavier Bassand
- Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Centre de Recherche d'Immunologie et d'Hématologie, Centre de Recherche en Biomédecine de Strasbourg (CRBS), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Strasbourg, France.,Nephrology-Transplantation Department, University Hospital, Strasbourg, France
| | - Sébastien Meyer
- Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Centre de Recherche d'Immunologie et d'Hématologie, Centre de Recherche en Biomédecine de Strasbourg (CRBS), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Franco (Strasbourg)-Japanese (Nagano) Nextgen HLA Laboratory, Strasbourg, France.,Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Strasbourg, France
| | - Loic Faucher
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,CHU Nantes, Université de Nantes, INSERM, Centre de Recherche en Transplantation et Immunologie, UMR 1064, ITUN, Nantes, France
| | - Juliane Posson
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale (INSERM), UMR_S 970, Paris, France.,Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Aurore Morlon
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,BIOMICA SAS, Strasbourg, France
| | - Irina Kotova
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,BIOMICA SAS, Strasbourg, France
| | - Florent Delbos
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Etablissement Français du Sang (EFS) Centre Pays de la Loire, Laboratoire HLA, Nantes, France
| | - Alexandre Walencik
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Etablissement Français du Sang (EFS) Centre Pays de la Loire, Laboratoire HLA, Nantes, France
| | - Alice Aarnink
- Laboratory of Histocompatibility, Centre Hospitalier Régional Universitaire, Nancy, France
| | - Anne Kennel
- Laboratory of Histocompatibility, Centre Hospitalier Régional Universitaire, Nancy, France
| | - Caroline Suberbielle
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Laboratoire Jean Dausset, Laboratoire d'Immunologie et d'Histocompatibilité, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 976, Human Immunology, Pathophysiology, Immunotherapy (HIPI), Institut de Recherche Saint-Louis Université de Paris, Hôpital Saint-Louis, Paris, France
| | - Jean-Luc Taupin
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Laboratoire Jean Dausset, Laboratoire d'Immunologie et d'Histocompatibilité, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 976, Human Immunology, Pathophysiology, Immunotherapy (HIPI), Institut de Recherche Saint-Louis Université de Paris, Hôpital Saint-Louis, Paris, France
| | - Benedict M Matern
- Center of Translational Immunology, HLA and Tissue Typing, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eric Spierings
- Center of Translational Immunology, HLA and Tissue Typing, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicolas Congy-Jolivet
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Laboratoire d'Immunogénétique Moléculaire (LIMT, EA 3034), Faculté de Médecine Purpan, Université Toulouse III (Université Paul Sabatier, UPS), Toulouse, France.,Laboratoire d'Immunologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Arnaud Essaydi
- Etablissement Français du Sang (EFS) Grand-Est, Laboratoire HLA, Strasbourg, France
| | - Peggy Perrin
- Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Centre de Recherche d'Immunologie et d'Hématologie, Centre de Recherche en Biomédecine de Strasbourg (CRBS), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Strasbourg, France.,Nephrology-Transplantation Department, University Hospital, Strasbourg, France
| | - Antoine Blancher
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Laboratoire d'Immunogénétique Moléculaire (LIMT, EA 3034), Faculté de Médecine Purpan, Université Toulouse III (Université Paul Sabatier, UPS), Toulouse, France.,Laboratoire d'Immunologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Dominique Charron
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Strasbourg, France.,Laboratoire Jean Dausset, Laboratoire d'Immunologie et d'Histocompatibilité, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 976, Human Immunology, Pathophysiology, Immunotherapy (HIPI), Institut de Recherche Saint-Louis Université de Paris, Hôpital Saint-Louis, Paris, France
| | | | - Myriam Maumy-Bertrand
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Strasbourg, France.,Institut de Recherche Mathématique Avancée (IRMA), Centre National de la Recherche Scientifique (CNRS) UMR 7501, Laboratoire d'Excellence (LabEx) Institut de Recherche en Mathématiques, Interactions et Applications (IRMIA), Université de Strasbourg, Strasbourg, France
| | - Frédéric Bertrand
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Strasbourg, France.,Institut de Recherche Mathématique Avancée (IRMA), Centre National de la Recherche Scientifique (CNRS) UMR 7501, Laboratoire d'Excellence (LabEx) Institut de Recherche en Mathématiques, Interactions et Applications (IRMIA), Université de Strasbourg, Strasbourg, France
| | - Valérie Garrigue
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Service de Néphrologie-Transplantation-Dialyse Péritonéale, Centre Hospitalier Universitaire Lapeyronie, Montpellier, France
| | - Vincent Pernin
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Service de Néphrologie-Transplantation-Dialyse Péritonéale, Centre Hospitalier Universitaire Lapeyronie, Montpellier, France
| | - Laurent Weekers
- Division of Nephrology, University of Liege Hospital (ULiege CHU), Liege, Belgium
| | - Maarten Naesens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Nassim Kamar
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Departments of Nephrology and Organ Transplantation, Centre Hospitalier Universitaire de Rangueil, INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Christophe Legendre
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Service de Transplantation Rénale Adulte, Hôpital Necker, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - Denis Glotz
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale (INSERM), UMR_S 970, Paris, France.,Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Sophie Caillard
- Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Centre de Recherche d'Immunologie et d'Hématologie, Centre de Recherche en Biomédecine de Strasbourg (CRBS), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Strasbourg, France.,Nephrology-Transplantation Department, University Hospital, Strasbourg, France
| | - Marc Ladrière
- Department of Renal Transplantation, Centre Hospitalier Régional Universitaire, Nancy, France
| | - Magali Giral
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,CHU Nantes, Université de Nantes, INSERM, Centre de Recherche en Transplantation et Immunologie, UMR 1064, ITUN, Nantes, France
| | - Dany Anglicheau
- Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Service de Transplantation Rénale Adulte, Hôpital Necker, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), UMR_S 1151, Paris, France
| | - Caner Süsal
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany.,Transplant Immunology Research Center of Excellence, Koç University, Istanbul, Turkey
| | - Seiamak Bahram
- Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Centre de Recherche d'Immunologie et d'Hématologie, Centre de Recherche en Biomédecine de Strasbourg (CRBS), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France. .,Laboratoire d'Excellence (LabEx) TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France. .,Institut National de la Santé et de la Recherche Médicale (INSERM) Franco (Strasbourg)-Japanese (Nagano) Nextgen HLA Laboratory, Strasbourg, France. .,Laboratoire d'Immunologie, Plateau Technique de Biologie, Pôle de Biologie, Nouvel Hôpital Civil, Strasbourg, France. .,Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Strasbourg, France.
| |
Collapse
|
30
|
Colas L, Royer AL, Massias J, Raux A, Chesneau M, Kerleau C, Guerif P, Giral M, Guitton Y, Brouard S. Urinary metabolomic profiling from spontaneous tolerant kidney transplanted recipients shows enrichment in tryptophan-derived metabolites. EBioMedicine 2022; 77:103844. [PMID: 35241402 PMCID: PMC9034456 DOI: 10.1016/j.ebiom.2022.103844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 12/27/2022] Open
Abstract
Background Operational tolerance is the holy grail in solid organ transplantation. Previous reports showed that the urinary compartment of operationally tolerant recipients harbor a specific and unique profile. We hypothesized that spontaneous tolerant kidney transplanted recipients (KTR) would have a specific urinary metabolomic profile associated to operational tolerance. Methods We performed metabolomic profiling on urine samples from healthy volunteers, stable KTR under standard and minimal immunosuppression and spontaneous tolerant KTR using liquid chromatography in tandem with mass spectrometry. Supervised and unsupervised multivariate computational analyses were used to highlight urinary metabolomic profile and metabolite identification thanks to workflow4metabolomic platform. Findings The urinary metabolome was composed of approximately 2700 metabolites. Raw unsupervised clustering allowed us to separate healthy volunteers and tolerant KTR from others. We confirmed by two methods a specific urinary metabolomic signature in tolerant KTR mainly driven by kynurenic acid independent of immunosuppressive drugs, serum creatinine and gender. Interpretation Kynurenic acid and tryptamine enrichment allowed the identification of putative pathways and metabolites associated with operational tolerance like IDO, GRP35 and AhR and indole alkaloids. Funding This study was supported by the ANR, IRSRPL and CHU de Nantes.
Collapse
Affiliation(s)
- Luc Colas
- CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Centre Hospitalier, Nantes Université, 30 bd Jean Monnet, Nantes F-44000, France.
| | - Anne-Lise Royer
- MELISA Core Facility, Oniris, INRΑE, Nantes F-44307, France; Laboratoire d'Etude des Résidus et Contaminants dans les Aliments (LABERCA), Oniris, INRAE, Nantes F-44307, France.
| | - Justine Massias
- MELISA Core Facility, Oniris, INRΑE, Nantes F-44307, France; Laboratoire d'Etude des Résidus et Contaminants dans les Aliments (LABERCA), Oniris, INRAE, Nantes F-44307, France.
| | - Axel Raux
- MELISA Core Facility, Oniris, INRΑE, Nantes F-44307, France; Laboratoire d'Etude des Résidus et Contaminants dans les Aliments (LABERCA), Oniris, INRAE, Nantes F-44307, France.
| | - Mélanie Chesneau
- CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Centre Hospitalier, Nantes Université, 30 bd Jean Monnet, Nantes F-44000, France.
| | - Clarisse Kerleau
- CHU Nantes, Service de Néphrologie-Immunologie Clinique, Nantes Université, Nantes, France.
| | - Pierrick Guerif
- CHU Nantes, Service de Néphrologie-Immunologie Clinique, Nantes Université, Nantes, France.
| | - Magali Giral
- CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Centre Hospitalier, Nantes Université, 30 bd Jean Monnet, Nantes F-44000, France; CHU Nantes, Service de Néphrologie-Immunologie Clinique, Nantes Université, Nantes, France; Centre d'Investigation Clinique en Biothérapie, Centre de Ressources Biologiques (CRB), Nantes, France.
| | - Yann Guitton
- MELISA Core Facility, Oniris, INRΑE, Nantes F-44307, France; Laboratoire d'Etude des Résidus et Contaminants dans les Aliments (LABERCA), Oniris, INRAE, Nantes F-44307, France.
| | - Sophie Brouard
- CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Centre Hospitalier, Nantes Université, 30 bd Jean Monnet, Nantes F-44000, France; CHU Nantes, Service de Néphrologie-Immunologie Clinique, Nantes Université, Nantes, France; Labex IGO, Nantes, France.
| |
Collapse
|
31
|
Ronsin C, Chaba A, Suchanek O, Coindre JP, Kerleau C, Garandeau C, Houzet A, Cantarovich D, Dantal J, Blancho G, Giral M, Couvrat-Desvergnes G, Ville S. Incidence, risk factors and outcomes of kidney and liver cyst infection in kidney transplant recipient with autosomal dominant polycystic kidney disease. Kidney Int Rep 2022; 7:867-875. [PMID: 35497795 PMCID: PMC9039903 DOI: 10.1016/j.ekir.2022.01.1062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 12/11/2022] Open
Abstract
Introduction Methods Results Conclusion
Collapse
|
32
|
Masset C, Gautier-Vargas G, Cantarovich D, Ville S, Dantal J, Delbos F, Walencik A, Kerleau C, Hourmant M, Garandeau C, Meurette A, Giral M, Benotmane I, Caillard S, Blancho G. Occurrence of de novo Donor Specific Antibodies after Covid-19 in kidney transplant recipients is low despite immunosuppression modulation. Kidney Int Rep 2022; 7:983-992. [PMID: 35155848 PMCID: PMC8818557 DOI: 10.1016/j.ekir.2022.01.1072] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/30/2021] [Accepted: 01/31/2022] [Indexed: 02/07/2023] Open
Abstract
Introduction Methods Results Conclusion
Collapse
Affiliation(s)
- Christophe Masset
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, France
- Correspondence: Christophe Masset, Service de Néphrologie et Immunologie Clinique, 30 bd Jean Monnet, 44093 Nantes Cedex 01, France.
| | - Gabriela Gautier-Vargas
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Strasbourg, France
| | - Diego Cantarovich
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Simon Ville
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, France
| | - Jacques Dantal
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, France
| | | | | | - Clarisse Kerleau
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Maryvonne Hourmant
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, France
| | - Claire Garandeau
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Aurélie Meurette
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Magali Giral
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, France
| | - Ilies Benotmane
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Strasbourg, France
| | - Sophie Caillard
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Strasbourg, France
| | - Gilles Blancho
- Service de Néphrologie et Immunologie Clinique Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, France
| |
Collapse
|
33
|
Masset C, Kandel-Aznar C, Dantal J, Giral M, Hourmant M, Blancho G, Garandeau C. OUP accepted manuscript. Clin Kidney J 2022; 15:1021-1023. [PMID: 35498898 PMCID: PMC9050533 DOI: 10.1093/ckj/sfac016] [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: 12/30/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
| | | | - Jacques Dantal
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, France
| | - Magali Giral
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, France
| | - Maryvonne Hourmant
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, France
| | - Gilles Blancho
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, France
| | - Claire Garandeau
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| |
Collapse
|
34
|
Masset C, Ville S, Garandeau C, Le Borgne F, Letellier T, Cantarovich D, Meurette A, Guillot-Gueguen C, Bentoumi-Loaec M, Giral M, Dantal J, Blancho G. Observations on improving COVID-19 vaccination responses in kidney transplant recipients: heterologous vaccination and immunosuppression modulation. Kidney Int 2021; 101:642-645. [PMID: 34890687 PMCID: PMC8651481 DOI: 10.1016/j.kint.2021.11.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 10/13/2021] [Revised: 10/20/2021] [Accepted: 11/30/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Christophe Masset
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France.
| | - Simon Ville
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Claire Garandeau
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Florent Le Borgne
- INSERM UMR 1246-SPHERE, Nantes University, Tours University, Nantes, France; IDBC-A2COM Group, Pacé, France
| | - Thibaut Letellier
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Diego Cantarovich
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Aurélie Meurette
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | | | - Maxime Bentoumi-Loaec
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Magali Giral
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Jacques Dantal
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Gilles Blancho
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
| |
Collapse
|
35
|
Ville S, Lorent M, Kerleau C, Asberg A, Legendre C, Morelon E, Buron F, Garrigue V, Le Quintrec M, Girerd S, Ladrière M, Albano L, Sicard A, Glotz D, Lefaucheur C, Branchereau J, Jacobi D, Giral M. Timing of Kidney Clamping and Deceased Donor Kidney Transplant Outcomes. Clin J Am Soc Nephrol 2021; 16:1704-1714. [PMID: 34625421 PMCID: PMC8729417 DOI: 10.2215/cjn.03290321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The fact that metabolism and immune function are regulated by an endogenous molecular clock that generates circadian rhythms suggests that the magnitude of ischemia reperfusion, and subsequent inflammation on kidney transplantation, could be affected by the time of the day. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We evaluated 5026 individuals who received their first kidney transplant from deceased heart-beating donors. In a cause-specific multivariable analysis, we compared delayed graft function and graft survival according to the time of kidney clamping and declamping. Participants were divided into those clamped between midnight and noon (ante meridiem [am] clamping group; 65%) or clamped between noon and midnight (post meridiem [pm] clamping group; 35%), and, similarly, those who underwent am declamping (25%) or pm declamping (75%). RESULTS Delayed graft function occurred among 550 participants (27%) with am clamping and 339 (34%) with pm clamping (adjusted odds ratio, 0.81; 95% confidence interval, 0.67 to 0.98; P=0.03). No significant association was observed between clamping time and overall death-censored graft survival (hazard ratio, 0.92; 95% confidence interval, 0.77 to 1.10; P=0.37). No significant association of declamping time with delayed graft function or graft survival was observed. CONCLUSIONS Clamping between midnight and noon was associated with a lower incidence of delayed graft function, whereas declamping time was not associated with kidney graft outcomes.
Collapse
Affiliation(s)
- Simon Ville
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Marine Lorent
- CRTI UMR 1064, Institut National de la Santé et de la Recherche Médicale (INSERM), University of Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France
| | - Clarisse Kerleau
- CRTI UMR 1064, Institut National de la Santé et de la Recherche Médicale (INSERM), University of Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France
| | - Anders Asberg
- Department of Transplantation Medicine, Oslo University Hospital, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Christophe Legendre
- Kidney Transplant Center, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, RTRS Centaure, Paris Descartes and Sorbonne Paris Cité Universities, Paris, France
| | - Emmanuel Morelon
- Nephrology, Transplantation and Clinical Immunology Department, RTRS Centaure, Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - Fanny Buron
- Nephrology, Transplantation and Clinical Immunology Department, RTRS Centaure, Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - Valérie Garrigue
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, Montpellier, France
| | - Moglie Le Quintrec
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, Montpellier, France
| | - Sophie Girerd
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - Marc Ladrière
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - Laetitia Albano
- Department of Nephrology and Renal Transplantation, Hospital Pasteur, Nice, France
| | - Antoine Sicard
- Department of Nephrology and Renal Transplantation, Hospital Pasteur, Nice, France
| | - Denis Glotz
- Department of Nephrology and Renal Transplantation, CHU Paris-GH Saint-Louis, Lariboisière, France
| | - Carmen Lefaucheur
- Department of Nephrology and Renal Transplantation, CHU Paris-GH Saint-Louis, Lariboisière, France
| | - Julien Branchereau
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France,Urology Unit, University of Nantes, ITUN, CHU Nantes, Nantes, France
| | - David Jacobi
- Thorax Institut, INSERM, Centre National de la Recherche Scientifique (CNRS), University of Nantes, CHU Nantes, Nantes, France
| | - Magali Giral
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France,INSERM, UMR 1246 SPHERE, Nantes University, Tours University, Nantes, France,Center for Clinical Investigation in Biotherapy, Nantes, France
| | | |
Collapse
|
36
|
Colas L, Bui L, Kerleau C, Lemdani M, Autain-Renaudin K, Magnan A, Giral M, Brouard S. Time-dependent blood eosinophilia count increases the risk of kidney allograft rejection. EBioMedicine 2021; 73:103645. [PMID: 34688031 PMCID: PMC8536518 DOI: 10.1016/j.ebiom.2021.103645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/14/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 01/21/2023] Open
Abstract
Background Growing evidence suggest that type 2 immune effectors play a role in solid organ transplantation. The aim of this study was to evaluate the impact of blood count eosinophils (BCEo) on immunological outcomes in kidney transplant recipients with stable graft function after 3 months post-transplant. Method We performed cause-specific Cox model considering BCEo, the use of calcineurin inhibitors and systemic corticoids as time-dependent explicative variables on a prospective cohort of 1013 kidney transplant patients who experienced kidney allograft rejection and/or the appearance of de novo donor specific antibodies after excluding common causes of increased BCEo.. Findings BCEo ≥ 0.3 G/L was associated with a 3-fold increased risk of rejection independent of immunosuppressive regimen after 3 months post-transplant in patients without pre-transplant DSAs and with CNI-based immunosuppression. No association between BCEo either with donor specific antibodies or graft survival was noticed. Interpretation These observations in this large cohort support the hypothesis of eosinophils in allo-immunity in human and claim for further mechanistic research. Funding This study was supported by the French National Research Agency, The “Institut de Recherche en Santé Respiratoire des Pays de la Loire” and the University hospital of Nantes.
Collapse
Affiliation(s)
- Luc Colas
- INSERM, CHU Nantes, Nantes Université, Centre de Recherche en Transplantation et Immunologie UMR1064, Centre Hospitalier Universitaire de Nantes, ITUN 30 bd Jean Monnet, Nantes 44093, France
| | - Linh Bui
- Centre Hospitalier de Mouscron, Belgique, Service de néphrologie, Belgium
| | - Clarisse Kerleau
- Service de Néphrologie-Immunologie Clinique, CHU Nantes, Nantes Université, Nantes, France
| | - Mohamed Lemdani
- Département of Biomathematiques, Faculté de Pharmacie and Biologie, Université de Lille, Lille, France
| | - Karine Autain-Renaudin
- INSERM, CHU Nantes, Nantes Université, Centre de Recherche en Transplantation et Immunologie UMR1064, Centre Hospitalier Universitaire de Nantes, ITUN 30 bd Jean Monnet, Nantes 44093, France; Département d'anatomie et Cytologie Pathologique, CHU Nantes, Nantes Université, Nantes, France
| | - Antoine Magnan
- Université de Versailles Saint-Quentin Paris-Saclay, Hôpital Foch, INRAe UMR 0892, Paris, Suresnes, France
| | - Magali Giral
- INSERM, CHU Nantes, Nantes Université, Centre de Recherche en Transplantation et Immunologie UMR1064, Centre Hospitalier Universitaire de Nantes, ITUN 30 bd Jean Monnet, Nantes 44093, France; Service de Néphrologie-Immunologie Clinique, CHU Nantes, Nantes Université, Nantes, France; Labex IGO, F-44000 Nantes, France.; Centre d'Investigation Clinique en Biothérapie, Institut de Transplantation Urology and Nephrology (ITUN), Centre Hospitalier Universitaire de Nantes, 30 bd Jean Monnet, Nantes 44093, France.
| | - Sophie Brouard
- INSERM, CHU Nantes, Nantes Université, Centre de Recherche en Transplantation et Immunologie UMR1064, Centre Hospitalier Universitaire de Nantes, ITUN 30 bd Jean Monnet, Nantes 44093, France; Labex IGO, F-44000 Nantes, France.; Centre d'Investigation Clinique en Biothérapie, Institut de Transplantation Urology and Nephrology (ITUN), Centre Hospitalier Universitaire de Nantes, 30 bd Jean Monnet, Nantes 44093, France.
| | | |
Collapse
|
37
|
Montero N, Toapanta N, Pallarès N, Crespo M, Diekmann F, Guirado L, Esteban R, Codina S, Melilli E, Buxeda A, Velis G, Torres IB, Revuelta I, Molina Andujar A, Facundo C, Bardají B, Riera L, Fiol M, Cruzado JM, Comas J, Giral M, Naesens M, Åsberg A, Moreso F, Bestard O. Deciphering transplant outcomes of expanded kidney allografts donated after controlled circulatory death in the current transplant era. A call for caution. Transpl Int 2021; 34:2494-2506. [PMID: 34626501 DOI: 10.1111/tri.14131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/01/2021] [Revised: 09/20/2021] [Accepted: 10/03/2021] [Indexed: 01/20/2023]
Abstract
Outcomes of kidney transplantation (KT) after controlled circulatory death (cDCD) with highly expanded criteria donors (ECD) and recipients have not been thoroughly evaluated. We analyzed in a multicenter cohort of 1161 consecutive KT, granular baseline donor and recipient factors predicting transplant outcomes, selected by bootstrapping and Cox proportional hazards, and were validated in a contemporaneous European KT cohort (n = 1585). 74.3% were DBD and 25.7% cDCD-KT. ECD-KT showed the poorest graft survival rates, irrespective of cDCD or DBD (log-rank < 0.001). Besides standard ECD classification, dialysis vintage, older age, and previous cardiovascular recipient events together with low class-II-HLA match, long cold ischemia time and combining a diabetic donor with a cDCD predicted graft loss (C-Index 0.715, 95% CI 0.675-0.755). External validation showed good prediction accuracy (C-Index 0.697, 95%CI 0.643-0.741). Recipient older age, male gender, dialysis vintage, previous cardiovascular events, and receiving a cDCD independently predicted patient death. Benefit/risk assessment of undergoing KT was compared with concurrent waitlisted candidates, and despite the fact that undergoing KT outperformed remaining waitlisted, remarkably high mortality rates were predicted if KT was undertaken under the worst risk-prediction model. Strategies to increase the donor pool, including cDCD transplants with highly expanded donor and recipient candidates, should be performed with caution.
Collapse
Affiliation(s)
- Nuria Montero
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Néstor Toapanta
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari Vall Hebrón, Barcelona, Spain
| | - Natàlia Pallarès
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Marta Crespo
- Kidney Transplant Unit, Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Fritz Diekmann
- Kidney Transplant Unit, Nephrology Department, Hospital Clínic Provincial, Institut d'Investigació Biomèdica August Pi i Sunyer, RedInRen, Barcelona, Spain
| | - Lluis Guirado
- Kidney Transplant Unit, Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Rafael Esteban
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Codina
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Edoardo Melilli
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Buxeda
- Kidney Transplant Unit, Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Gonzalo Velis
- Kidney Transplant Unit, Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Irina B Torres
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari Vall Hebrón, Barcelona, Spain
| | - Ignacio Revuelta
- Kidney Transplant Unit, Nephrology Department, Hospital Clínic Provincial, Institut d'Investigació Biomèdica August Pi i Sunyer, RedInRen, Barcelona, Spain
| | - Alicia Molina Andujar
- Kidney Transplant Unit, Nephrology Department, Hospital Clínic Provincial, Institut d'Investigació Biomèdica August Pi i Sunyer, RedInRen, Barcelona, Spain
| | - Carme Facundo
- Kidney Transplant Unit, Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Beatriz Bardají
- Kidney Transplant Unit, Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Lluís Riera
- Urology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Maria Fiol
- Urology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Josep M Cruzado
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Comas
- Catalan Organ Transplant Organization, Barcelona, Spain
| | - Magali Giral
- CRTI UMR 1064, Inserm, Université de Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France
| | - Maarten Naesens
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Francesc Moreso
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari Vall Hebrón, Barcelona, Spain
| | - Oriol Bestard
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
38
|
Ouahmi H, Moceri P, Zorzi K, Albano L, Durand M, Karimi F, Morelon E, Buron F, Le Quintrec M, Pernin V, Ladriere M, Girerd S, Dantal J, Loupy A, Couzi L, Ferrari E, Esnault V, Merville P, Legendre C, Giral M, Sicard A. Cohort study: "Outcomes of kidney transplantation in patients with prosthetic heart valves". Transpl Int 2021; 34:2297-2304. [PMID: 34425020 DOI: 10.1111/tri.14008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/11/2021] [Indexed: 11/29/2022]
Abstract
The number of kidney transplant candidates with prosthetic heart valves (PHVs) is increasing. Yet, outcomes of kidney transplantation in these patients are still unclear. This is the first report of post-transplant outcomes in patients with PHVs at time of kidney transplantation. We conducted a matched cohort study among recipients from the multicentric and prospective DIVAT cohort to compare the outcomes in patients with left-sided PHVs at time of transplantation and a group of recipients without PHV matched according to age, dialysis time, initial disease, pretransplant DSA, diabetes, and cardiovascular events. Of 23 018 patients, 92 patients with PHVs were included and compared to 276 patients without PHV. Delayed graft function and postoperative bleeding occurred more frequently in patients with PHVs. Kidney graft survival was similar between groups. 5-year overall survival was 68.5% in patients with PHV vs. 87.9% in patients without PHV [HR, 2.72 (1.57-4.70), P = 0.0004]. Deaths from infection, endocarditis, and bleeding were more frequent in patients with PHV. Mechanical valves, but not bioprosthetic valves, were independent risk factors for mortality [HR, 2.89 (1.68-4.97), P = 0.0001]. Patients with PHV have high mortality rates after kidney transplantation. These data suggest that mechanical valves, but not biological valves, increase risks of post-transplant mortality.
Collapse
Affiliation(s)
- Hajar Ouahmi
- Nephrology, Dialysis and Transplantation Department, Pasteur 2 Hospital, Nice University Hospital, Nice, France.,Clinical Research Unit of Côte d'Azur University (UR2CA), Nice, France
| | - Pamela Moceri
- Clinical Research Unit of Côte d'Azur University (UR2CA), Nice, France.,Cardiology Department, Pasteur 2 Hospital, Nice University Hospital, Nice, France
| | - Kevin Zorzi
- Nephrology, Dialysis and Transplantation Department, Pasteur 2 Hospital, Nice University Hospital, Nice, France.,Clinical Research Unit of Côte d'Azur University (UR2CA), Nice, France
| | - Laetitia Albano
- Nephrology, Dialysis and Transplantation Department, Pasteur 2 Hospital, Nice University Hospital, Nice, France
| | - Matthieu Durand
- Urology Department, Pasteur 2 Hospital, Nice University Hospital, Nice, France
| | - Fatimaezzahra Karimi
- Nephrology, Dialysis and Transplantation Department, Pasteur 2 Hospital, Nice University Hospital, Nice, France
| | - Emmanuel Morelon
- Nephrology, Transplantation and Clinical Immunology Department, RTRS « Centaure », Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - Fanny Buron
- Nephrology, Transplantation and Clinical Immunology Department, RTRS « Centaure », Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - Moglie Le Quintrec
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Vincent Pernin
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Marc Ladriere
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - Sophie Girerd
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - Jacques Dantal
- CRTI UMR 1064, Inserm, ITUN, CHU Nantes, RTRS Centaure, Université de Nantes, Nantes, France.,Centre d'Investigation Clinique en Biothérapie, Nantes, France
| | - Alexandre Loupy
- Kidney Transplant Center, Necker University Hospital, APHP, RTRS «Centaure», Paris Descartes and Sorbonne Paris Cité Universities, Paris, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin Hospital, Bordeaux University Hospital, Bordeaux, France.,UMR CNRS 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Emile Ferrari
- Cardiology Department, Pasteur 2 Hospital, Nice University Hospital, Nice, France
| | - Vincent Esnault
- Nephrology, Dialysis and Transplantation Department, Pasteur 2 Hospital, Nice University Hospital, Nice, France.,Clinical Research Unit of Côte d'Azur University (UR2CA), Nice, France
| | - Pierre Merville
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin Hospital, Bordeaux University Hospital, Bordeaux, France.,UMR CNRS 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Christophe Legendre
- Kidney Transplant Center, Necker University Hospital, APHP, RTRS «Centaure», Paris Descartes and Sorbonne Paris Cité Universities, Paris, France
| | - Magali Giral
- CRTI UMR 1064, Inserm, ITUN, CHU Nantes, RTRS Centaure, Université de Nantes, Nantes, France.,Centre d'Investigation Clinique en Biothérapie, Nantes, France
| | - Antoine Sicard
- Nephrology, Dialysis and Transplantation Department, Pasteur 2 Hospital, Nice University Hospital, Nice, France.,Clinical Research Unit of Côte d'Azur University (UR2CA), Nice, France.,CNRS, UMR7370, Laboratory of Molecular PhysioMedicine, LP2M, Nice, France
| | | |
Collapse
|
39
|
Lenain R, Prouteau C, Hamroun A, Foucher Y, Giral M, Maanaoui M, Hazzan M. Association Between Deceased Donor Acute Kidney Injury Assessed Using Baseline Serum Creatinine Back-Estimation and Graft Survival: Results From the French National CRISTAL Registry. Am J Kidney Dis 2021; 79:164-174. [PMID: 34416353 DOI: 10.1053/j.ajkd.2021.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/19/2021] [Indexed: 01/23/2023]
Abstract
RATIONALE & OBJECTIVE Deceased donor acute kidney injury (AKI) frequently leads to kidney discards, but its impact on long-term graft survival in kidney transplant recipients remains unclear. We investigated the association between deceased donor AKI assessed using back-estimation of baseline serum creatinine (Scr) and graft survival. STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS Adult patients represented within the French CRISTAL registry who received a single kidney allograft from brain-dead deceased donors between January 2006 and December 2017. EXPOSURE A back-estimated Scr baseline value was derived for an assumed glomerular filtration rate at 75mL/min/1.73m2, using the MDRD Study equation. A refined classification system for donor AKI was implemented as follows: no AKI, undetermined AKI/chronic kidney disease (CKD), recovery from AKI, and ongoing AKI. OUTCOME Death-censored graft survival. ANALYTICAL APPROACH Multivariable Cox models using a robust variance estimator for paired kidneys from the same donor. RESULTS We classified 26,786 recipients as follows: no AKI (n=19,276); undetermined AKI/CKD (n=1,745); recovery from AKI (n=2,392); and ongoing AKI (n=3,373). We observed 4,458 kidney graft losses during a median follow-up period of 5.7 years. Compared with no AKI, ongoing AKI was associated with an increased risk of graft failure (hazard ratio [HR], 1.24 [95% CI, 1.13-1.35]). The HRs for graft failure in the undetermined AKI/CKD and recovery from AKI groups (1.22 [95% CI, 1.07-1.38] and 1.18 [95% CI, 1.06-1.31], respectively) were similar to those observed in the ongoing AKI group. The adverse effect of deceased donor AKI was no longer evident when relying either on the admission or the lowest Scr throughout the procurement procedure as baseline Scr. LIMITATIONS No measurement of urine output in donors. CONCLUSIONS Deceased donor ongoing AKI, undetermined AKI/CKD, and recovery from AKI according to back-estimated baseline Scr are associated with decreased graft survival. The definition of baseline Scr as the first value measured on admission would have led to a misclassification bias and erroneous estimates.
Collapse
Affiliation(s)
- Rémi Lenain
- Department of Nephrology, Lille University Hospital, Lille, France.
| | - Camille Prouteau
- Department of Nephrology, Lille University Hospital, Lille, France
| | - Aghilès Hamroun
- Department of Nephrology, Lille University Hospital, Lille, France
| | - Yohann Foucher
- INSERM UMR 1246, SPHERE, University of Nantes, Tours University, Nantes, France; Nantes University Hospital, Nantes, France
| | - Magali Giral
- CRTI UMR 1064, INSERM, Université de Nantes ITUN, CHU Nantes RTRS Centaure, Nantes, France
| | - Mehdi Maanaoui
- Department of Nephrology, Lille University Hospital, Lille, France; University of Lille, INSERM U1190, Translational Research for Diabetes, Lille, France
| | - Marc Hazzan
- Department of Nephrology, Lille University Hospital, Lille, France
| | | |
Collapse
|
40
|
Bestard O, Meneghini M, Crespo E, Bemelman F, Koch M, Volk HD, Viklicky O, Giral M, Banas B, Ruiz JC, Melilli E, Hu L, van Duivenvoorden R, Nashan B, Thaiss F, Otto NM, Bold G, Stein M, Sefrin A, Lachmann N, Hruba P, Stranavova L, Brouard S, Braudeau C, Blancho G, Banas M, Irure J, Christakoudi S, Sanchez-Fueyo A, Wood KJ, Reinke P, Grinyó JM. Preformed T cell alloimmunity and HLA eplet mismatch to guide immunosuppression minimization with tacrolimus monotherapy in kidney transplantation: Results of the CELLIMIN trial. Am J Transplant 2021; 21:2833-2845. [PMID: 33725408 DOI: 10.1111/ajt.16563] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/08/2021] [Accepted: 02/26/2021] [Indexed: 02/06/2023]
Abstract
Personalizing immunosuppression is a major objective in transplantation. Transplant recipients are heterogeneous regarding their immunological memory and primary alloimmune susceptibility. This biomarker-guided trial investigated whether in low immunological-risk kidney transplants without pretransplant DSA and donor-specific T cells assessed by a standardized IFN-γ ELISPOT, low immunosuppression (LI) with tacrolimus monotherapy would be non-inferior regarding 6-month BPAR than tacrolimus-based standard of care (SOC). Due to low recruitment rates, the trial was terminated when 167 patients were enrolled. ELISPOT negatives (E-) were randomized to LI (n = 48) or SOC (n = 53), E+ received the same SOC. Six- and 12-month BPAR rates were higher among LI than SOC/E- (4/35 [13%] vs. 1/43 [2%], p = .15 and 12/48 [25%] vs. 6/53 [11.3%], p = .073, respectively). E+ patients showed similarly high BPAR rates than LI at 6 and 12 months (12/55 [22%] and 13/66 [20%], respectively). These differences were stronger in per-protocol analyses. Post-hoc analysis revealed that poor class-II eplet matching, especially DQ, discriminated E- patients, notably E-/LI, developing BPAR (4/28 [14%] low risk vs. 8/20 [40%] high risk, p = .043). Eplet mismatch also predicted anti-class-I (p = .05) and anti-DQ (p < .001) de novo DSA. Adverse events were similar, but E-/LI developed fewer viral infections, particularly polyoma-virus-associated nephropathy (p = .021). Preformed T cell alloreactivity and HLA eplet mismatch assessment may refine current baseline immune-risk stratification and guide immunosuppression decision-making in kidney transplantation.
Collapse
Affiliation(s)
- Oriol Bestard
- Kidney Transplant Unit, Nephrology department, Bellvitge University Hospital, IDIBELL, Barcelona University, Barcelona, Spain.,Nephrology and Transplantation Laboratory, IDIBELL, Barcelona University, Barcelona, Spain
| | - Maria Meneghini
- Kidney Transplant Unit, Nephrology department, Bellvitge University Hospital, IDIBELL, Barcelona University, Barcelona, Spain.,Nephrology and Transplantation Laboratory, IDIBELL, Barcelona University, Barcelona, Spain
| | - Elena Crespo
- Nephrology and Transplantation Laboratory, IDIBELL, Barcelona University, Barcelona, Spain
| | - Frederike Bemelman
- Renal Transplant Unit, Department of Internal Medicine, Amsterdam University Medical Centers, Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
| | - Martina Koch
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans D Volk
- BeCAT, BCRT, and Department of Nephrology & Intensive Care, Charité Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ondrej Viklicky
- Transplant Laboratory, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.,Department of Nephrology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Magali Giral
- Nantes Université, Inserm, CHU Nantes, Centre de Recherche en Transplantation et Immunologie UMR1064, ITUN, Nantes, France
| | - Bernhard Banas
- Department of Nephrology, University Medical Center Regensburg, Regensburg, Germany
| | - Juan C Ruiz
- Department of Nephrology, Hospital Universitario "Marqués de Valdecilla", Instituto de Investigación "Marqués de Valdecilla" (IDIVAL, Santander, Spain
| | - Edoardo Melilli
- Kidney Transplant Unit, Nephrology department, Bellvitge University Hospital, IDIBELL, Barcelona University, Barcelona, Spain
| | - Liu Hu
- Renal Transplant Unit, Department of Internal Medicine, Amsterdam University Medical Centers, Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
| | - Raphael van Duivenvoorden
- Renal Transplant Unit, Department of Internal Medicine, Amsterdam University Medical Centers, Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
| | - Björn Nashan
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friedrich Thaiss
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Natalie M Otto
- BeCAT, BCRT, and Department of Nephrology & Intensive Care, Charité Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany
| | - Gantuja Bold
- BeCAT, BCRT, and Department of Nephrology & Intensive Care, Charité Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany
| | - Maik Stein
- BeCAT, BCRT, and Department of Nephrology & Intensive Care, Charité Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany
| | - Anett Sefrin
- BeCAT, BCRT, and Department of Nephrology & Intensive Care, Charité Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany
| | - Nils Lachmann
- HLA-Laboratory, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Petra Hruba
- Transplant Laboratory, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.,Department of Nephrology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Lucia Stranavova
- Transplant Laboratory, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.,Department of Nephrology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Sophie Brouard
- Nantes Université, Inserm, CHU Nantes, Centre de Recherche en Transplantation et Immunologie UMR1064, ITUN, Nantes, France
| | - Cécile Braudeau
- Nantes Université, Inserm, CHU Nantes, Centre de Recherche en Transplantation et Immunologie UMR1064, ITUN, Nantes, France.,CHU Nantes, Laboratoire d'immunologie, CIMNA, Nantes, France
| | - Gilles Blancho
- Nantes Université, Inserm, CHU Nantes, Centre de Recherche en Transplantation et Immunologie UMR1064, ITUN, Nantes, France
| | - Miriam Banas
- Department of Nephrology, University Medical Center Regensburg, Regensburg, Germany
| | - Juan Irure
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Sophia Christakoudi
- Institute of Liver Studies, MRC Centre for Transplantation, Department of Inflammation Biology, Faculty of Sciences & Medicine, King's College London, London, UK
| | - Alberto Sanchez-Fueyo
- Institute of Liver Studies, MRC Centre for Transplantation, Department of Inflammation Biology, Faculty of Sciences & Medicine, King's College London, London, UK
| | - Kathryn J Wood
- Transplantation Research and Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Petra Reinke
- BeCAT, BCRT, and Department of Nephrology & Intensive Care, Charité Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany
| | - Josep M Grinyó
- Kidney Transplant Unit, Nephrology department, Bellvitge University Hospital, IDIBELL, Barcelona University, Barcelona, Spain.,Nephrology and Transplantation Laboratory, IDIBELL, Barcelona University, Barcelona, Spain
| |
Collapse
|
41
|
Mesnard B, Leroy M, Hunter J, Kervella D, Timsit MO, Badet L, Glemain P, Morelon E, Buron F, Le Quintrec-Donnette M, Pernin V, Ladriere M, Girerd S, Legendre C, Sicard A, Albano L, De Vergie S, Kerleau C, Prudhomme T, Rigaud J, Cantarovich D, Blancho G, Karam G, Giral M, Ville S, Branchereau J. Kidney transplantation from expanded criteria donors: an increased risk of urinary complications - the UriNary Complications Of Renal Transplant (UNyCORT) study. BJU Int 2021; 129:225-233. [PMID: 34114727 DOI: 10.1111/bju.15509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the impact of expanded criteria donors (ECD) on urinary complications in kidney transplantation. PATIENTS AND METHODS The UriNary Complications Of Renal Transplant (UNyCORT) is a cohort study based on the French prospective Données Informatisées et VAlidées en Transplantation/Computerized and VAlidated Data in Transplantation (DIVAT) cohort. Data were extracted between 1 January 2002 and 1 January 2018 with 1-year minimum follow-up, in relation to 44 pre- and postoperative variables. ECD status was included according to United Network for Organ Sharing (UNOS) definition. The primary outcome of the UNyCORT study was the association between the donor's ECD/standard criteria donors (SCD) status and urinary complications at 1 year in uni- and multivariate analysis. Sub-group analysis, stratified analysis on ECD/SCD donor's status and transplant failure analysis were then conducted. RESULTS Between 1 January 2002 and 1 January 2018, 10 279 kidney transplants in adult recipients were recorded within the DIVAT network. A total of 8559 (83.4%) donors were deceased donors and 1699 (16.6%) were living donors (LD). Among donation after circulatory death (DCD) donors, 224 (2.85%) were uncontrolled DCD and 93 (1.09%) were controlled DCD donors. A total of 3617 (43.9%) deceased donors were ECD. The overall urological complication rate was 16.26%. The donor's ECD status was significantly associated with an increased risk of urological complications at 1 year in multivariate analysis (odds ratio: 1.50, 95% CI 1.31-1.71; P < 0.001) and especially with stenosis and ureteric fistulae at 1 year. There is no association with LD, uncontrolled and controlled DCD. The placement of an endo-ureteric stent was beneficial in preventing urinary complications in all donors and particularly in ECD donors. CONCLUSION The donor's ECD status is associated with a higher likelihood of stenosis and ureteric fistulae at 1 year. Recipients of grafts from ECD donors should probably be considered for closer urological monitoring and systematic preventive measures.
Collapse
Affiliation(s)
- Benoit Mesnard
- Clinique Urologique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France
| | - Maxime Leroy
- Plateforme de Méthodologie et de Biostatistique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France
| | - James Hunter
- Nuffield Department of Surgical Science, Oxford, UK
| | - Delphine Kervella
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | | | - Lionel Badet
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices de Lyon, Lyon, France
| | - Pascal Glemain
- Clinique Urologique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France
| | - Emmanuel Morelon
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices de Lyon, Lyon, France
| | - Fanny Buron
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices de Lyon, Lyon, France
| | | | - Vincent Pernin
- Service de Néphrologie-Soins Intensifs-Dialyse et Transplantation, Hôpital Lapeyronie, Montpellier, France
| | - Marc Ladriere
- Service de Transplantation Rénale, CHU Brabois, Nancy, France
| | - Sophie Girerd
- Service de Transplantation Rénale, CHU Brabois, Nancy, France
| | | | | | | | | | - Clarisse Kerleau
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | - Thomas Prudhomme
- Service Urologie, Andrologie et Transplantation Rénale, CHU de Toulouse, Hôpital Rangeuil, Toulouse, France
| | - Jérôme Rigaud
- Clinique Urologique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France
| | - Diego Cantarovich
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | - Gilles Blancho
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | - Georges Karam
- Clinique Urologique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France
| | - Magali Giral
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | - Simon Ville
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | - Julien Branchereau
- Clinique Urologique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France.,Nuffield Department of Surgical Science, Oxford, UK.,CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | | |
Collapse
|
42
|
Geneviève M, Sartorius A, Giral M, Janbon B, Merville P, Legendre C, Combe C, Moreau K. Poor kidney graft survival in anorexia nervosa patients. Eat Weight Disord 2021; 26:1447-1455. [PMID: 32666377 DOI: 10.1007/s40519-020-00959-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/08/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Anorexia nervosa is a condition associated with poor outcomes in a variety of circumstances such as recurrence of eating disorders, psychiatric disorders, and organ damage. OBJECTIVE In the present study, we first sought to determine the 5-year kidney graft survival in patients with anorexia nervosa and then to evaluate the BMI course and medical complications. METHODS In this multicenter, retrospective, case-control study, we analyzed the impact of anorexia nervosa on graft outcomes compared to transplant recipients with low or normal BMI. RESULTS We enrolled 137 women in this study: 19 with anorexia nervosa, 59 with low BMI (BMI < 18.5 kg/m2), and 59 with normal BMI (18.5-24.9 kg/m2). Anorexia nervosa was significantly associated with lower graft survival compared to either of the other groups (hazard ratio 5.5 [95% CI 3.4-8.9], p = 0.005); there was no difference in graft survival between patients with low or normal BMI. Cardiovascular complications were more frequent in the anorexia nervosa group (37%) than in patients with low (6%) or normal BMI (7%) (p = 0.001). CONCLUSION We conclude that patients with anorexia nervosa should be considered a high-risk group. LEVEL OF EVIDENCE Level III, evidence obtained from well-designed cohort or case-control analytic studies.
Collapse
Affiliation(s)
- Magalie Geneviève
- Service de Néphrologie Dialyse, Hôpital Privé Francheville, 4 Place Francheville, 24000, Périgueux, France.
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
| | - Albane Sartorius
- Service de Néphrologie Dialyse Transplantation, Hôpital Foch, Suresnes, France
| | - Magali Giral
- Centre Hospitalier Universitaire de Nantes, Institut Transplantation Urologie Néphrologie, Nantes, France
- Université de Nantes, Nantes, France
| | - Bénédicte Janbon
- Service Néphrologie-Transplantation Rénale-Dialyse, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Pierre Merville
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - Christophe Legendre
- Service de Néphrologie Dialyse Transplantation, Hôpital Necker, Paris, France
- Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - Karine Moreau
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| |
Collapse
|
43
|
Masset C, Branchereau J, Karam G, Hourmant M, Dantal J, Giral M, Garandeau C, Meurette A, Kerleau C, Kervella D, Ville S, Blancho G, Cantarovich D. Clinical utility of C-peptide measurement after pancreas transplantation with especial focus on early graft thrombosis. Transpl Int 2021; 34:942-953. [PMID: 33733553 DOI: 10.1111/tri.13866] [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: 01/06/2021] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 11/26/2022]
Abstract
Since the beginning of our pancreas transplant programme, plasma C-peptide was routinely measured daily during the postoperative period. We aimed to evaluate the clinical interest of the C-peptide in the follow-up of pancreas transplantation with a particular look on early graft failure. From 2000 to 2016, 384 pancreas transplantations were evaluated. We collected and compared C-peptide, glycaemia and adjusted C-peptide (aCP; calculated based on C-peptide, glycaemia and creatininaemia) in patients with and without pancreas failure within 30 days after surgery. Variations of glycaemia, C-peptide and aCP between the day before and the day of failure were also recorded. The difference of aCP was significant during the first week after transplantation between patients with thrombosis and those with functional allograft: 63.2 vs. 26.7 on day 1, P = 0.0003; 61.4 vs. 26.7 on day 3, P < 0.0001; 64.8 vs. 5.7 on day 7, P < 0.0001, respectively. Glycaemia had a median increase of 8% on the day of failure, whereas C-peptide and aCP had, respectively, a median decrease of 88% and 83%. C-peptide monitoring after pancreas transplantation may help to identify graft function and early failure. This sensitive biomarker could allow pre-emptive diagnosis of an early thrombotic event allowing the possibility of rescue interventions.
Collapse
Affiliation(s)
- Christophe Masset
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Julien Branchereau
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Georges Karam
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Maryvonne Hourmant
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Jacques Dantal
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Magali Giral
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Claire Garandeau
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Aurélie Meurette
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Clarisse Kerleau
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Delphine Kervella
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Simon Ville
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Gilles Blancho
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Diego Cantarovich
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| |
Collapse
|
44
|
Foucher Y, Lorent M, Albano L, Roux S, Pernin V, Le Quintrec M, Legendre C, Buron F, Morelon E, Girerd S, Ladrière M, Glotz D, Lefaucher C, Kerleau C, Dantal J, Branchereau J, Giral M. Renal transplantation outcomes in obese patients: a French cohort-based study. BMC Nephrol 2021; 22:79. [PMID: 33673808 PMCID: PMC7934368 DOI: 10.1186/s12882-021-02278-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/21/2021] [Indexed: 12/24/2022] Open
Abstract
Background Whilst there are a number of publications comparing the relationship between body mass index (BMI) of kidney transplant recipients and graft/patient survival, no study has assessed this for a French patient cohort. Methods In this study, cause-specific Cox models were used to study patient and graft survival and several other time-to-event measures. Logistic regressions were performed to study surgical complications at 30 days post-transplantation as well as delayed graft function. Results Among the 4691 included patients, 747 patients were considered obese with a BMI level greater than 30 kg/m2. We observed a higher mortality for obese recipients (HR = 1.37, p = 0.0086) and higher risks of serious bacterial infections (HR = 1.24, p = 0.0006) and cardiac complications (HR = 1.45, p < 0.0001). We observed a trend towards death censored graft survival (HR = 1.22, p = 0.0666) and no significant increased risk of early surgical complications. Conclusions We showed that obesity increased the risk of death and serious bacterial infections and cardiac complications in obese French kidney transplant recipients. Further epidemiologic studies aiming to compare obese recipients versus obese candidates remaining on dialysis are needed to improve the guidelines for obese patient transplant allocation. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02278-1.
Collapse
Affiliation(s)
- Y Foucher
- INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France. .,Centre Hospitalier Universitaire de Nantes, Nantes, France.
| | - M Lorent
- INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France.,Centre Hospitalier Universitaire de Nantes, Nantes, France.,CRTI UMR 1064, Inserm, Université de Nantes; ITUN, CHU Nantes; RTRS Centaur, Nantes, France
| | - L Albano
- Department of Nephrology and Renal Transplantation, Hospital Pasteur, Nice, France
| | - S Roux
- INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
| | - V Pernin
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, Montpellier, France
| | - M Le Quintrec
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, Montpellier, France
| | - C Legendre
- Kidney Transplant Center, Necker University Hospital, APHP, RTRS « Centaure », Paris Descartes and Sorbonne Paris Cité Universities, Paris, France
| | - F Buron
- Nephrology, Transplantation and Clinical Immunology Department, RTRS « Centaure », Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - E Morelon
- Nephrology, Transplantation and Clinical Immunology Department, RTRS « Centaure », Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - S Girerd
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - M Ladrière
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - D Glotz
- Department of Nephrology and Renal Transplantation, CHU Paris-GH St-Louis Lariboisière F. Widal, Paris, France
| | - C Lefaucher
- Department of Nephrology and Renal Transplantation, CHU Paris-GH St-Louis Lariboisière F. Widal, Paris, France
| | - C Kerleau
- Centre Hospitalier Universitaire de Nantes, Nantes, France.,CRTI UMR 1064, Inserm, Université de Nantes; ITUN, CHU Nantes; RTRS Centaur, Nantes, France
| | - J Dantal
- Centre Hospitalier Universitaire de Nantes, Nantes, France.,CRTI UMR 1064, Inserm, Université de Nantes; ITUN, CHU Nantes; RTRS Centaur, Nantes, France.,Centre d'Investigation Clinique en Biothérapie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - J Branchereau
- Centre Hospitalier Universitaire de Nantes, Nantes, France.,CRTI UMR 1064, Inserm, Université de Nantes; ITUN, CHU Nantes; RTRS Centaur, Nantes, France.,Centre d'Investigation Clinique en Biothérapie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - M Giral
- Centre Hospitalier Universitaire de Nantes, Nantes, France.,CRTI UMR 1064, Inserm, Université de Nantes; ITUN, CHU Nantes; RTRS Centaur, Nantes, France.,Centre d'Investigation Clinique en Biothérapie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | | |
Collapse
|
45
|
Lenain R, Dantan E, Giral M, Foucher Y, Asar Ö, Naesens M, Hazzan M, Fournier MC. External Validation of the DynPG for Kidney Transplant Recipients. Transplantation 2021; 105:396-403. [PMID: 32108750 DOI: 10.1097/tp.0000000000003209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In kidney transplantation, dynamic prediction of patient and kidney graft survival (DynPG) may help to promote therapeutic alliance by delivering personalized evidence-based information about long-term graft survival for kidney transplant recipients. The objective of the current study is to externally validate the DynPG. METHODS Based on 6 baseline variables, the DynPG can be updated with any new serum creatinine measure available during the follow-up. From an external validation sample of 1637 kidney recipients with a functioning graft at 1-year posttransplantation from 2 European transplantation centers, we assessed the prognostic performance of the DynPG. RESULTS As one can expect from an external validation sample, differences in several recipient, donor, and transplantation characteristics compared with the learning sample were observed. Patients were mainly transplanted from deceased donors (91.6% versus 84.8%; P < 0.01), were less immunized against HLA class I (18.4% versus 32.7%; P < 0.01) and presented less comorbidities (62.2% for hypertension versus 82.7%, P < 0.01; 25.1% for cardiovascular disease versus 33.9%, P < 0.01). Despite these noteworthy differences, the area under the ROC curve varied from 0.70 (95% confidence interval [CI], 0.64-0.76) to 0.76 (95% CI, 0.64-0.88) for prediction times at 1 and 6 years posttransplantation respectively, and calibration plots revealed reasonably accurate predictions. CONCLUSIONS We validated the prognostic capacities of the DynPG in terms of both discrimination and calibration. Our study showed the robustness of the DynPG for informing both the patient and the physician, and its transportability for a cohort presenting different features than the one used for the DynPG development.
Collapse
Affiliation(s)
- Rémi Lenain
- Department of Nephrology, Huriez Hospital, Lille University Hospital, Lille, France
| | - Etienne Dantan
- INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
| | - Magali Giral
- CRTI UMR 1064, Inserm, Université de Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France
- Centre d'Investigation Clinique en Biothérapie, Nantes, France
| | - Yohann Foucher
- INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
- Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Özgür Asar
- Department of Biostatistics and Medical Informatics, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Maarten Naesens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Marc Hazzan
- Department of Nephrology, Huriez Hospital, Lille University Hospital, Lille, France
| | | |
Collapse
|
46
|
Van Loon E, Giral M, Anglicheau D, Lerut E, Dubois V, Rabeyrin M, Brouard S, Roedder S, Spigarelli MG, Rabant M, Bogaerts K, Naesens M, Thaunat O. Diagnostic performance of kSORT, a blood-based mRNA assay for noninvasive detection of rejection after kidney transplantation: A retrospective multicenter cohort study. Am J Transplant 2021; 21:740-750. [PMID: 32627407 DOI: 10.1111/ajt.16179] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/04/2020] [Accepted: 06/20/2020] [Indexed: 01/25/2023]
Abstract
The Kidney Solid Organ Response Test (kSORT) blood gene expression assay was developed to noninvasively detect acute rejection (AR) after kidney transplantation. Its performance in a setting with natural disease prevalence has not been evaluated. A retrospective, multicenter cohort study was conducted across all single kidney transplant recipients, transplanted between 2011 and 2015, with samples within the first year after transplantation available in existing biobanks. The primary objective was to determine the diagnostic performance of the kSORT assay to detect AR (T cell-mediated and/or antibody-mediated rejection) as compared to a concomitant renal biopsy. AR was reported on the concomitant biopsy in 188 of 1763 (10.7%) blood samples and any rejection (including borderline changes) in 614 of 1763 (34.8%) blood samples. In 320 of 1763 samples (18.2%) the kSORT risk category was indeterminate. The kSORT assay had no diagnostic value for AR (area under the curve [AUC] 0.51, 95% confidence interval [CI] 0.50-0.56; P = .46) overall, or when considering indication biopsies (N = 487) and protocol-specified biopsies (N = 1276) separately (AUC of 0.53, 95% CI 0.50-0.59, P = .44 and 0.55, 95% CI 0.50-0.61, P = .09, respectively). This large retrospective study utilizing samples obtained under real-world clinical conditions, was unable to validate the kSORT assay for detection of AR in the first year after transplantation.
Collapse
Affiliation(s)
- Elisabet Van Loon
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Nephrology, Leuven, Belgium.,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Magali Giral
- CRTI UMR 1064, Inserm, University of Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France.,Institute for Transplantation Urology Nephrology (ITUN), CHU Nantes, Nantes, France.,Faculty of Medicine, University of Nantes, Nantes, France.,CIC Biotherapy, CHU Nantes, Nantes, France
| | - Dany Anglicheau
- Paris Descartes, University of Paris, INSERM U1151, Paris, France.,Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Evelyne Lerut
- Department of Imaging and Pathology, University Hospitals Leuven, Translational Cell & Tissue Research, Leuven, Belgium
| | - Valérie Dubois
- French National Blood Service (EFS), HLA Laboratory, Décines-Charpieu, France
| | - Maud Rabeyrin
- Department of Pathology, Hospices Civils de Lyon, Bron, France
| | - Sophie Brouard
- CRTI UMR 1064, Inserm, University of Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France.,Institute for Transplantation Urology Nephrology (ITUN), CHU Nantes, Nantes, France.,Faculty of Medicine, University of Nantes, Nantes, France.,CIC Biotherapy, CHU Nantes, Nantes, France
| | | | | | - Marion Rabant
- Department of Renal Pathology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Kris Bogaerts
- KU Leuven, I-BioStat, Leuven, Belgium.,UHasselt, I-BioStat, Hasselt, Belgium
| | - Maarten Naesens
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Nephrology, Leuven, Belgium.,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Thaunat
- French National Institute of Health and Medical Research (Inserm) Unit 1111, Lyon, France.,Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital Lyon, Hospices Civils de Lyon, Lyon, France.,Lyon-Est Medical Faculty, Claude Bernard University (Lyon 1), Lyon, France
| |
Collapse
|
47
|
Mesnard B, Leroy M, Hunter J, Kervella D, Timsit M, Badet L, Glemain P, Prudhomme T, Dantal J, De Vergie S, Bouchot O, Rigaud J, Karam G, Giral M, Branchereau J. Transplantations rénales à partir de donneurs décédés par arrêt circulatoire contrôlé M3 et non contrôlé M2 : un impact sur les complications urinaires ? Étude multicentrique de 317 transplantations DDAC. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
48
|
Boucquemont J, Foucher Y, Masset C, Legendre C, Scemla A, Buron F, Morelon E, Garrigue V, Pernin V, Albano L, Sicard A, Girerd S, Ladrière M, Giral M, Dantal J. Induction therapy in kidney transplant recipients: Description of the practices according to the calendar period from the French multicentric DIVAT cohort. PLoS One 2020; 15:e0240929. [PMID: 33091057 PMCID: PMC7580969 DOI: 10.1371/journal.pone.0240929] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022] Open
Abstract
Background There is extensive literature with comparisons between Anti-Thymocyte Globulin (ATG) and Basiliximab (BSX) as induction therapy in kidney transplant recipients. The purpose of our benchmarking study was to describe the consequences in terms of practices in 6 transplantation centers of a French prospective cohort. Methods We included adult patients who received a first or second kidney graft between 2013 and 2019 (n = 4157). We used logistic regressions to identify characteristics associated with the use of ATG or BSX. Results Use of ATG between the centers ranged from 41% to 75%. We observed different factors associated with the treatment decision. Compared to a first transplant, performing a second graft was the only factor significantly associated with the choice of ATG in all centers. The AUC ranged from 0.67 to 0.91, indicating that the centers seemed to define their own rules. As a result, for patients with the same low immunological risk, the probability of receiving ATG varied from 7% to 36%. We stratified the analyses according to two periods, from 2013 to 2015 and from 2016 to 2019. A similar heterogeneity was observed, and in some cases ATG indications between the centers were inverted. Conclusions The heterogeneity of induction therapy practices did not decrease in France, even if the reated literature is prolific. This illustrates the necessity to improve the literature by using meta-analyses of recent studies stratified by graft and patient profiles.
Collapse
Affiliation(s)
- Julie Boucquemont
- INSERM UMR 1246—SPHERE, Nantes University, Tours University, Nantes, France
- * E-mail: (JD); (JB)
| | - Yohann Foucher
- INSERM UMR 1246—SPHERE, Nantes University, Tours University, Nantes, France
- Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Christophe Masset
- Centre Hospitalier Universitaire de Nantes, Nantes, France
- CRTI UMR 1064, Inserm, Université de Nantes; ITUN, CHU Nantes; RTRS « Centaure », Nantes, France
| | - Christophe Legendre
- Kidney Transplant Center, Necker University Hospital, APHP, RTRS « Centaure », Paris Descartes and Sorbonne Paris Cité Universities, Paris, France
| | - Anne Scemla
- Kidney Transplant Center, Necker University Hospital, APHP, RTRS « Centaure », Paris Descartes and Sorbonne Paris Cité Universities, Paris, France
| | - Fanny Buron
- Nephrology, Transplantation and Clinical Immunology Department, RTRS « Centaure », Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - Emmanuel Morelon
- Nephrology, Transplantation and Clinical Immunology Department, RTRS « Centaure », Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - Valérie Garrigue
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, Montpellier, France
| | - Vincent Pernin
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, Montpellier, France
| | - Laetitia Albano
- Department of Nephrology and Renal Transplantation, Hospital Pasteur, Nice, France
| | - Antoine Sicard
- Department of Nephrology and Renal Transplantation, Hospital Pasteur, Nice, France
| | - Sophie Girerd
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - Marc Ladrière
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - Magali Giral
- Centre Hospitalier Universitaire de Nantes, Nantes, France
- CRTI UMR 1064, Inserm, Université de Nantes; ITUN, CHU Nantes; RTRS « Centaure », Nantes, France
- Centre d’Investigation Clinique en Biothérapie, Nantes, France
| | - Jacques Dantal
- Centre Hospitalier Universitaire de Nantes, Nantes, France
- CRTI UMR 1064, Inserm, Université de Nantes; ITUN, CHU Nantes; RTRS « Centaure », Nantes, France
- * E-mail: (JD); (JB)
| | | |
Collapse
|
49
|
Masset C, Ville S, Halary F, Gaborit B, Bressolette-Bodin C, Deltombe C, Dujardin A, Jacquemont L, Lebot S, Kervella D, Figueres L, Cantarovich D, Giral M, Hourmant M, Blancho G, Garandeau C, Meurette A, Dantal J. Resurgence of BK virus following Covid-19 in kidney transplant recipients. Transpl Infect Dis 2020; 23:e13465. [PMID: 32939955 DOI: 10.1111/tid.13465] [Citation(s) in RCA: 4] [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: 07/03/2020] [Revised: 08/11/2020] [Accepted: 08/28/2020] [Indexed: 12/14/2022]
Abstract
Kidney transplant recipients have been supposed vulnerable to severe Covid-19 infection, due to their comorbidities and immunosuppressive therapies. Mild-term complications of Covid-19 are currently unknown, especially in this population. Herein, we report two cases of BKV replication after non-severe SARS-CoV-2 infection. The first case was a 59-year-old man, transplanted 3 months ago, with recent history of slight BKV viremia (3.3 log10 DNA copies/ml). Despite strong reduction of maintenance immunosuppression (interruption of mycophenolic acid and important decrease of calcineurin inhibitors), BKV replication largely increased after Covid-19 and viremia persisted at 4.5 log copy/ml few months later. The second case was a 53-year-old woman, transplanted 15 years ago. She had a recent history of BKV cystitis, which resolved with a decrease of MPA dosage. Few weeks after SARS-CoV-2 infection, she presented recurrence of lower urinary tract symptoms. Our reports highlight that SARS-CoV-2 infection, even without severity, could disrupt immune system and particularly lymphocytes, thus leading to viral replication. Monitoring of viral replications after Covid-19 in kidney transplant recipients could permit to confirm these preliminary observations.
Collapse
Affiliation(s)
- Christophe Masset
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France
| | - Simon Ville
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France.,Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Franck Halary
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Benjamin Gaborit
- Infectious Diseases Department, Centre Hospitalier Universitaire, Nantes, France
| | | | - Clément Deltombe
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France
| | - Amaury Dujardin
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France
| | - Lola Jacquemont
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France.,Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Sabine Lebot
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France
| | - Delphine Kervella
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France.,Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Lucille Figueres
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France.,Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Diego Cantarovich
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France
| | - Magali Giral
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France.,Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Maryvonne Hourmant
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France.,Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Gilles Blancho
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France.,Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Claire Garandeau
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France
| | - Aurélie Meurette
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France
| | - Jacques Dantal
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France.,Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| |
Collapse
|
50
|
Chesneau M, Mai HL, Danger R, Le Bot S, Nguyen TVH, Bernard J, Poullaouec C, Guerrif P, Conchon S, Giral M, Charreau B, Degauque N, Brouard S. Efficient Expansion of Human Granzyme B–Expressing B Cells with Potent Regulatory Properties. J I 2020; 205:2391-2401. [DOI: 10.4049/jimmunol.2000335] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/10/2020] [Indexed: 01/12/2023]
|