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Highly sensitized kidney recipients

Hassan Argani
Recent developments have been achieved for better matching in solid-organ transplantation by epitope matching. HLA matching remains a standard immunologic strategy to determine organ compatibility for recipients. Advancements in tissue typing have introduced HLA matching at the epitope level. For this, B cells are able to recognize polymorphic amino acid configurations, which are named epitopes. However, antibody production against these epitopes may be a leading cause of rejection. Although data to support the added clinical benefit of epitope matching over traditional antigen matching are still lacking, there are at least 2 theoretical reasons for epitope matching: (1) to avoid future allosensitization with the development of anti-HLA antibodies and (2) to allow selection of a suitable allograft for highly sensitized patients through virtual crossmatch...
January 2019: Experimental and Clinical Transplantation
Giuseppe Leonardi, Mariadelina Simeoni, Michele Bozzo, Alfredo Caglioti, Giorgio Fuiano
Biliary hamartomas (BH) are rare benign lesions of the liver characterized by a dilation of a variable number of small biliary ducts, usually surrounded by abundant fibrotic tissue. These malformations are due to an aberrant remodelling of the ductal plate, that is the embryonic structure generating the normal biliary tree. BH are usually asymptomatic, but in rare cases they can be associated with jaundice, heartburn and fever. Evidences for a sharing of similar pathological pathways between BH and adult dominant polycystic kidney disease (ADPKD) are widely reported...
February 2019: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Fei Han, Shaogui Wan, Qipeng Sun, Nan Chen, Heng Li, Lingling Zheng, Nana Zhang, Zhengyu Huang, Liangqing Hong, Qiquan Sun
BACKGROUND: The lack of accurate biomarkers makes it difficult to determine whether organs are suitable for transplantation. Mitochondrial DNA (mtDNA) correlates with tissue damage and kidney disease, making it a potential biomarker in organ evaluation. METHODS: Donors who had experienced cardiac death and successfully donated their kidneys between January 2015 and May 2017 were included this study. We detected the level of mtDNA in the plasma of the donor using quantitative real-time polymerase chain reaction, and then statistically analyzed the relationship between the level of mtDNA and the delayed graft function (DGF) of the recipient...
February 4, 2019: Transplantation
M Matignon, J-D Lelièvre, A Lahiani, K Abbassi, D Desvaux, A Diallo, M-N Peraldi, A-M Taburet, J Saillard, C Delaugerre, D Costagliola, L Assoumou, P Grimbert
OBJECTIVES: High rates of clinical acute rejection after kidney transplantation have been reported in people living with HIV (PLHIV), probably as a consequence of drug interactions. We therefore investigated the incidence of acute rejection within 6 months of transplantation in HIV-infected recipients treated with a protease-inhibitor-free raltegravir-based regimen. METHODS: The Agence Nationale de Recherche sur le Sida et les Hépatites Virales (ANRS) 153 TREVE (NCT01453192) study was a prospective multicentre single-arm trial in adult PLHIV awaiting kidney transplantation, with viral load < 50 HIV-1 RNA copies/mL, CD4 T-cell count > 200 cells/μL, and HIV-1 strains sensitive to raltegravir, aiming to demonstrate 6-month clinical acute rejection rates < 30%...
January 27, 2019: HIV Medicine
M Gregorini, V Martinelli, E Ticozzelli, M Canevari, G Fasoli, E F Pattonieri, F Erasmi, M Valente, P Esposito, A Contardi, M A Grignano, A Pietrabissa, M Abelli, T Rampino
BACKGROUND: Living donor kidney transplantation (LDKT) is the best therapy for patients with chronic renal failure. Its advantages, compared with cadaveric transplantation, include the possibility of avoiding dialysis, the likelihood of best outcome, and donor pool expansion. Careful assessment of potential donors is important to minimize the risks and ensure success. However, the proportion of donors disqualified has been poorly investigated. The aim of this work is to describe our experience and present the main reasons for missed donation...
June 30, 2018: Transplantation Proceedings
Tong Her, Ted E Schutzbank
BK virus (BKV) nephropathy is a serious complication in renal transplant recipients due to the need for immunosuppression. Nearly 50% of renal transplant patients with BKV nephropathy experience a significant loss of function of the transplanted kidney. It is routine practice to screen renal transplant recipients regularly for BK viremia. In this study, we compared the performance of BKV quantitative polymerase chain reaction analyte specific reagents by ELITech and Luminex for measuring BKV viral load in plasma using the Roche Cobas® z480 instrument and the Luminex ARIES® platform, respectively...
December 15, 2018: Diagnostic Microbiology and Infectious Disease
Francesca Zanoni, Carlo Alfieri, Gabriella Moroni, Patrizia Passerini, Anna Regalia, Maria Meneghini, Piergiorgio Messa
West Nile virus infection is more frequently associated with neuroinvasive disease and high morbidity and mortality in immunocompromised hosts. Here, we describe a 47-year-old Egyptian kidney transplant recipient who was admitted to our department in 2016 for persistent fever, altered mental status, and upper limb tremors. In addition, renal impairment, signs of acute thrombotic microangiopathy, pancreatitis, and slightly altered inflammatory indices were present. The patient was treated with antibacterial and antiviral therapy, and reduced immunosuppressive therapy was prescribed...
December 31, 2018: Experimental and Clinical Transplantation
D Kim, I Gimferrer, P Warner, K Nelson, L Sibulesky, R Bakthavatsalam, N Leca
Antibodies against angiotensin II type-1 receptors (AT1R) have been increasingly recognized in association with rejection and poor allograft outcomes. Our goal was to define the prevalence of preformed antibodies against AT1R and evaluate the association with renal allograft outcomes in a consecutive cohort of 150 transplant recipients. IgG antibodies against AT1R were measured by enzyme-linked immunosorbent assay using cryopreserved serum samples obtained for HLA testing at the time of transplantation. Results were categorized as negative if <10 U/mL (44%), intermediate from 10 to 17 U/mL (38%), or strongly positive if >17 U/mL (18%)...
December 2018: Transplantation Proceedings
Nele Kirsten Kanzelmeyer, Petra Zürbig, Harald Mischak, Jochen Metzger, Alexander Fichtner, Kristzina Heindl Ruszai, Tomas Seemann, Matthias Hansen, Simone Wygoda, Kai Krupka, Burkhard Tönshoff, Anette Melk, Lars Pape
Chronic antibody-mediated rejection (cABMR) is the main cause of long-term renal graft loss. Late-stage diagnosis is made by detecting donor-specific antibodies (DSA) in blood combined with typical histomorphological lesions in renal allografts. There is a need for non-invasive biomarkers for cABMR that might permit screening and earlier diagnosis. In a case control study of 24 pediatric renal transplant recipients urine samples were analyzed using capillary electrophoresis and mass spectrometry. Patients were matched with 36 pediatric renal transplant patients without cABMR...
October 25, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Aureliusz Kolonko, Beata Bzoma, Piotr Giza, Beata Styrc, Michał Sobolewski, Jerzy Chudek, Alicja Dębska-Ślizień, Andrzej Więcek
Background : The panel-reactive antibodies that use the complement-dependent cytotoxicity test (PRA-CDC) are still a standard method for monitoring the degree of immunization in kidney transplant candidates on active waiting lists in some countries, including Poland. The aim of this study was to analyze the relationship between the maximum and the last pre-transplant PRA titer on the percentage of positive cross-matches and rate of early acute rejection episodes. Material and methods : The retrospective analysis included 528 patients from two transplant centers...
September 20, 2018: Medicina
Kristen Sgambat, Sarah Clauss, Asha Moudgil
BACKGROUND: Kidney transplant recipients are at high risk for CV morbidity. However, the measure of obesity that best predicts CV risk has not been established. OBJECTIVE: A prospective, controlled study was conducted to compare the ability of BMI, WC, and WHr to identify CV risk in pediatric kidney transplant recipients. METHODS: Transplant recipients, aged 3-20 years, had echocardiogram, CIMT, BMI, WC, WHr, blood pressure, lipids, and leptin measured...
December 2018: Pediatric Transplantation
Elisabet Estil Les, Noèlia Téllez, Montserrat Nacher, Eduard Montanya
Streptozotocin (STZ) is a cytotoxic glucose analogue that causes beta cell death and is widely used to induce experimental diabetes in rodents. The sensitivity of beta cells to STZ is species-specific and human beta cells are resistant to STZ. In experimental islet transplantation to rodents, STZ-diabetes must be induced before transplantation to avoid destruction of grafted islets by STZ. In human islet transplantation, injection of STZ before transplantation is inconvenient and costly, since human islet availability depends on organ donation and frail STZ-diabetic mice must be kept for unpredictable lapses of time until a human islet preparation is available...
October 1, 2018: Cell Transplantation
Renata von Glehn Ponsirenas, Helena B Cazarote, Stanley de Almeida Araújo, David Campos Wanderley, Silvia Shimakura, Joana S Valdameri, Fabiana L C Contieri, Cristina C Q C von Glehn, Michelle F Susin, Vanessa Santos Sotomaior
Background: The identification of low-level antibodies by single-antigen bead methodology has brought advancements to risk evaluation of kidney transplant recipients. However, the use of mean fluorescence intensity (MFI) to quantify antibodies and to guide therapy is not enough. Notably, immunoglobulin G (IgG) subclass switching is hypothesized to follow a programmed sequence after an emergency signal from the germinal center. In transplantation this process is not clear yet. In the present study, we sequentially evaluate anti-HLA donor specific antibody (DSA) subclasses, their profile changes, and C1q-binding ability and the influence of those characteristics on antibody mediated rejection (AMR) occurrence and allograft function...
September 2018: Transplantation Direct
David Solar-Cafaggi, Lluvia Marino, Norma Uribe-Uribe, Luis Eduardo Morales-Buenrostro
BACKGROUND: Antibody-mediated rejection (ABMR) is the leading cause of kidney graft loss worldwide. Criteria for acute humoral rejection (currently labeled active humoral rejection) established by the 2007 Banff classification are highly specific but lack sensitivity. Modifications to the Banff classification were introduced for its 2013 and 2017 versions in order to identify more cases of this entity. PURPOSE: We intend to demonstrate that, compared to its 2007 version, the 2017 Banff classification bears an improved capacity for graft loss prediction when histologic criteria for active ABMR are met...
December 2018: Transplant Immunology
E Brochot, V Descamps, L Handala, J Faucher, G Choukroun, F Helle, S Castelain, C François, G Duverlie, A Touzé
OBJECTIVES: After kidney transplantation, human BK polyomavirus (BKPyV) can induce a progressive disease, in three stages: viruria, viraemia, and then nephropathy after a few months of viral replication. Therapeutic intervention is recommended when BKPyV is detected in the plasma. The objective of our study was to assess urinary BKPyV nucleic acid test as a predictor for developing viraemia. METHODS: We first defined a viruria threshold based on 393 time-matched urine and plasma samples collected after kidney transplantation; to validate this threshold, we followed-up a cohort of 236 kidney transplant patients...
January 2019: Clinical Microbiology and Infection
D Kamińska, M Łukaszewski, N Kozera, K Kościelska-Kasprzak, D Bartoszek, O Mazanowska, W Goździk, P Chudoba, P Zaleska, A Lepiesza, M Klinger
Previously transplanted highly sensitized patients experience problems with subsequent transplantation. It is also difficult to provide optimal hemodynamic conditions during successive kidney transplantation in heart transplant recipients. PATIENT AND METHODS: We present a case of a 56-year old patient with end-stage renal failure after heart transplantation performed 21 years ago and hemodialyzed using arteriovenous fistula. The patient had 69% panel-reactive antibodies, had been on the active waiting list since 2013, and presented 335 positive crossmatches with deceased donors...
July 2018: Transplantation Proceedings
J Malyszko, E Koc-Żórawska, J S Malyszko
INTRODUCTION: Endocan is a novel soluble dermatan sulfate proteoglycan derived from endothelium. It has the capacity of binding to different biologically active molecules associated with cellular signaling, adhesion and regulating proliferation, differentiation, migration, and adhesion of different cell types in health and pathology. Elevated endocan levels are connected with endothelial activation/damage, neo-angiogenesis, and inflammation or carcinogenesis. MATERIALS AND METHODS: The level of serum endocan among 63 kidney transplant recipients on three immunosuppressives (calcineurin inhibitors, mycophenolate mofetil, steroids) in correlation with other markers of endothelial damage was estimated...
July 2018: Transplantation Proceedings
Elisa Gabanti, Daniele Lilleri, Lucia Scaramuzzi, Paola Zelini, Teresa Rampino, Giuseppe Gerna
Human cytomegalovirus (HCMV)-specific T-cell response in kidney transplant recipients (KTR) helps to identify patients at risk for severe infection. To assess the T-cell response, this study compared our in-house developed reference test, based on T-cell (both CD4+ and CD8+) stimulation by autologous HCMV-infected dendritic cells (iDC) and subsequent detection by cytokine flow cytometry (CFC-iDC), with the Quanti-FERON-CMV (QF-CMV) assay. Fifty-three HCMV-seropositive KTR were enrolled. At the DNAemia peak, 33 (62%) had low viral load (LVL, <3x105 DNA copies/mL) self-resolving infection, 19 (36%) high viral load (HVL, >3x105 DNA copies/mL) infection treated with antivirals, and one LVL patient (2%) tissue-invasive disease alone...
July 2018: New Microbiologica
Daqiang Zhao, Tao Liao, Siwen Li, Yannan Zhang, Haofeng Zheng, Jing Zhou, Fei Han, Yu Dong, Qiquan Sun
Antibody-mediated rejection (AMR) is the main barrier to renal graft survival, and mouse renal AMR models are important to study this process. Current mouse models are established by priming the recipient to donor skin for over 7 days before kidney transplantation. The robustness of AMR in these cases is too strong to mimic clinical AMR and it is unclear why altering the priming times ranging from 7 to 91 days fails to reduce the AMR potency in these models. In the present study, we found that the donor-recipient combination and skin graft size were determinants of donor-specific antibody (DSA) development patterns after skin transplantation...
2018: Frontiers in Immunology
A Kowada
OBJECTIVES: Tuberculosis (TB) is a serious infectious disease with high mortality for solid-organ transplantation. Preventive therapy of latent tuberculosis infection (LTBI) has been considered to reduce TB risk and improve outcomes of transplantation. The aim of this study was to evaluate the cost-effectiveness of the interferon-gamma release assays (IGRAs); QuantiFERON® -TB Gold in-Tube (QFT) and T-SPOT® .TB (TSPOT)), for kidney, liver and lung transplant recipients in low TB incidence countries...
July 24, 2018: Journal of Infection
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