Immunopathology of T cell mediated rejection
|
|
- Jacob Watts
- 6 years ago
- Views:
Transcription
1 Immunopathology of T cell mediated rejection Ibrahim Batal MD Columbia University College of Physicians & Surgeons New York, NY, USA
2 Overview Pathophysiology and grading of TCMR TCMR is still a significant diagnostic entity New look of TCMR
3 Rejection New MHC molecules (Allo-antigens) Rejection: TCMR, AMR, or both
4 AMR TCMR Nickeleit et al. Kidney Int 2007 Mengel et al. Am J Transplant 2009
5 Donor APC TCMR 1990s DCs Monocytes B Cells Cytotoxic or Helper T cell Recipient APC Helper T cell Cytotoxic T cell Abbas & Lichtman 2005
6 T cell activation CD40 CD40L Signal 1: Allo-Ag presentation Signal 2: Co-Stimulation signals Signal 3: Cytokine signals Clonal expansion IL2 Cytotoxic Perforin Granzyme Helper Cytokines Pollard et al. Trends Mol Med 2013
7 CD8 (Cytotoxic) CD4 (helper) CD4 (Helper) CD8 (Cytotoxic) CD8 (Cytotoxic) CD8 (Cytotoxic) Abbas & Lichtman 2005
8 Typical TCMR CD4 CD8
9 Solez et al. Kidney Int 1993 Racusen et al. Kidney Int 1999 Features of TCMR by Banff Classification (all assessed semi-quantitatively from 0 to 3) Established at 1991 meeting and further shaped in 1997 Intimal arteritis (v; 0-3) Tubulitis (t; 0-3) (no, mild, >25% arterial lumina, transmural or fibrinoid necrosis) (no, 1-5, 5-10, >10 or >2 disruptive tubulitis) Interstitial inflammation (i; 0-3) (nonscarred cortex) (<10%, 10-25%, 26-50%, >50%)
10 The Banff 97 Classification for TCMR Grade III (v3): arterial fibrinoid necrosis and/or transmural arteritis Grade IIB (v2): intimal arteritis occluding >25% of the luminal area Grade IIA (v1): milder intimal arteritis Grade IB: i >2 (>25% of non-scarred cortex) & severe tubulitis (t3) Grade IA: i >2 (>25% of non-scarred cortex) & mod tubulitis (t2) Racusen et al Kidney Int 1999
11 The Banff 97 Classification for TCMR Grade III (v3): arterial fibrinoid necrosis and/or transmural arteritis Grade IIB (v2): intimal arteritis occluding >25% of the luminal area Grade IIA (v1): milder intimal arteritis Grade IB: i >2 (>25% of non-scarred cortex) & severe tubulitis (t3) Grade IA: i >2 (>25% of non-scarred cortex) & mod tubulitis (t2) Racusen et al Kidney Int 1999
12 The Banff 97 Classification for TCMR Grade III (v3): arterial fibrinoid necrosis and/or transmural arteritis Grade IIB (v2): intimal arteritis occluding >25% of the luminal area Grade IIA (v1): milder intimal arteritis Grade IB: i >2 (>25% of non-scarred cortex) & severe tubulitis (t3) Grade IA: i >2 (>25% of non-scarred cortex) & mod tubulitis (t2) Racusen et al Kidney Int 1999
13 The Banff 97 Classification for TCMR Grade III (v3): arterial fibrinoid necrosis and/or transmural arteritis Grade IIB (v2): intimal arteritis occluding >25% of the luminal area Grade IIA (v1): milder intimal arteritis Grade IB: i >2 (>25% of non-scarred cortex) & severe tubulitis (t3) Grade IA: i >2 (>25% of non-scarred cortex) & mod tubulitis (t2) Racusen et al Kidney Int 1999
14 The Banff 97 Classification for TCMR Grade III (v3): arterial fibrinoid necrosis and/or transmural arteritis Grade IIB (v2): intimal arteritis occluding >25% of the luminal area Grade IIA (v1): milder intimal arteritis Grade IB: i >2 (>25% of non-scarred cortex) & severe tubulitis (t3) Grade IA: i >2 (>25% of non-scarred cortex) & mod tubulitis (t2) Borderline/suspicious TCMR: not meeting above (at least i=1, t=1) Racusen et al Kidney Int 1999
15 Other solid organs TCMR Interstitial inflammatory infiltrate and cytotoxic parenchymal injury
16 1R: 1 focus of myocyte damage 2R: 2 or more foci of myocyte damage 3R: diffuse inflammation and multiple foci of myocyte damage
17 Interstitial inflammation (portal tract) AND Cytotoxic injury to the bile duct and venules Combined score: grade of rejection: mild, moderate, severe
18 Cytotoxic injury to crypt: apoptotic bodies
19 TCMR Treatment Prevention: Potent induction and maintenance IS If TCMR occurs despite prophylaxis (CUMC): Corticosteroids (BL, 1A): low doses nonspecific immunosuppressive agents, which decrease T cell activation & block cytokine genes: inhibit IL-1, IL-2, IL-3, IL-6, IL-15, TNFα and INF-γ; High doses may be directly toxic to T cells Thymoglobulin (1B & above): Depletes lymphocytes
20 TCMR is not significant anymore With current potent IS regimens: Decrease in early TCMR (Meier-Kriesche et al. AJT 2004) TCMR is not associated with graft loss (Halloran et al. AJT 2013) Disappearance of TCMR transcript signal in the late post-transplant period (Halloran et al. JASN 2015) Early atcmr 1st year post-transplant (%) % ~10% 2011 Meier-Kriesche et al. Am J Transplant 2004 Halloran et al. Am J Transplant 2013 Halloran et al. J Am Soc Nephrol 2015
21 TCMR is not significant anymore With current potent IS regimens: Decrease in early TCMR (later, more difficult to treat) TCMR is not associated with graft loss (HR: 1.79, Cr & egfr: NP) Disappearance of TCMR transcript signal in the late post-transplant period (Diagnostic for TCMR by > 2 pathologists; Banff criteria: iifta) Early atcmr 1st year post-transplant (%) % ~10% 2011 Meier-Kriesche et al. Am J Transplant 2004 Halloran et al. Am J Transplant 2013 Halloran et al. J Am Soc Nephrol 2015
22 TCMR is still significant 1 18 pure TCMR and 14 non-inflamed controls (dysfunction biopsies) Patient never had C4d or DSA Late: vs days 41% of patients with TCMR showed no response to steroids Patients with TCMR had more deterioration in renal function at 2- year post-biopsy 2 years post-biopsy Rise of Cr above baseline (%) 80 * TCMR Controls Zhao et al. Transplantation 2016
23 TCMR is still significant 2 TCMR is a predictor for subsequent development of de novo DSA (Wiebe et al. AJT 2012) Tubulitis is an independent predictor for poor graft survival in patients with de novo DSA (Wiebe et al. AJT 2015) Wiebe et al. Am J Transplant 2012 Wiebe et al. Am J Transplant 2015
24 TCMR is still significant 1. Not all studies showed that TCMR is not important 2. TCMR may be a predictor for AMR and may also predict prognosis in patients with AMR 3. Change our classic appreciation of TCMR, adapt more liberal view
25 New concept of TCMR Changes: 1990s current time 1. Improvement of induction and maintenance immunosuppression 2. Expansion of donor pool
26 Induction Immunosuppression In USA 90% Signal 1 1. Induction (Basiliximab) therapy has Rituximab advanced a lot; 80% was not used in most patients in 1980s- 70% Signal s 60% 50% 40% 30% 20% 10% IL2R antagonists Alemtuzumab (Campath) 0% Courtesy of A Chandraker; modified
27 Azathioprine Maintenance immunosuppression Cyclosporine Tacrolimus (FK506) Mycophenolate Mofetil (MMF) Rapamycin (Sirolimus) Belatacept Tacrolimus Belatacept Rapamycin (mtori) MMF: anti-proliferation Zand. Semin Dial Shrestha et al. Prog Transplant 2015 Karam et al. Crit Rev Eukaryot Gene Expr 2015
28 Expansion of donor pool ECD & DCD: prone to IFTA/chronic changes (solitary kidney) Extended Criteria Donor (ECD) Donation after Cardiac Death (DCD) Shrestha et al. Prog Transplant 2015
29 Decreased TCMR & more prominent IFTA 60 55% Early atcmr 1st year post-transplant (%) Later TCMR ~10% Meier-Kriesche Hu et al. Am J Transplant iglietti et al. Transplantation 2015
30 Changing of TCMR Less fulminant TCMR, more scarring, and more inflammation in the areas of cortical scarring iifta So what is iifta and is it significant?
31 iifta is associated with graft loss Mengel et al: ti: i + iifta had similar proinflammatory transcription profile but worse prognosis than conventional TCMR Mannon et al: Patients with iatr/iifta had worse allograft survival than patients without iatr/iifta ti, which includes iifta, may potentially represent a broader spectrum of TCMR than what is currently recognized by Banff ti <25% ti >25% P<0.001 Mengel et al. Am J Transplant 2009 Mannon et al. Am J Transplant 2010
32 Phenotype of lymphocytic inflammation in iifta CD4 CD8
33 iifta is associated with graft loss 100 Confirmed that ti/iifta is associated with poor prognosis iifta include active inflammation with interaction between dendritic cells and proliferative lymphocytes Batal et al. J Am Soc Nephrol 2015 Graft survival (%) T cells proliferation index (%) ti0-1 ti2-3 P<0.001 (log rank test) Post-biopsy time (days) Low DC-SIGN P=0.014 High DC-SIGN
34 Summary TCMR is still an important diagnostic entity Current Banff classification is not optimal for TCMR (iifta is a classification problem) In addition to morphologic classifications, we need to invest more in pathophysiology of TCMR New therapies may be required to further control smoldering/chronic TCMR (iifta)
35
Supplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Lefaucheur C, Loupy A, Vernerey D, et al. Antibody-mediated
More informationPathological back-ground of renal transplant pathology and important mile-stones of the Banff classification
Banff 1 Banff Pathological back-ground of renal transplant pathology and important mile-stones of the Banff classification Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital Morozumi Kunio,
More informationOverview of New Approaches to Immunosuppression in Renal Transplantation
Overview of New Approaches to Immunosuppression in Renal Transplantation Ron Shapiro, M.D. Professor of Surgery Surgical Director, Kidney/Pancreas Transplant Program Recanati/Miller Transplantation Institute
More informationHLA and Non-HLA Antibodies in Transplantation and their Management
HLA and Non-HLA Antibodies in Transplantation and their Management Luca Dello Strologo October 29 th, 2016 Hystory I 1960 donor specific antibodies (DSA): first suggestion for a possible role in deteriorating
More informationManagement of Rejection
Management of Rejection I have no disclosures Disclosures (relevant or otherwise) Deborah B Adey, MD Professor of Medicine University of California, San Francisco Kidney and Pancreas Transplant Center
More informationRenal Pathology- Transplantation. Eva Honsova Institute for Clinical and Experimental Medicine Prague, Czech Republic
Renal Pathology- Transplantation Eva Honsova Institute for Clinical and Experimental Medicine Prague, Czech Republic eva.honsova@ikem.cz Kidney has a limited number of tissue reactions by which the kidney
More informationJames E. Cooper, M.D. Assistant Professor, University of Colorado at Denver Division of Renal Disease and Hypertension, Kidney and PancreasTransplant
James E. Cooper, M.D. Assistant Professor, University of Colorado at Denver Division of Renal Disease and Hypertension, Kidney and PancreasTransplant Program Has no real or apparent conflicts of interest
More informationTRANSPLANT IMMUNOLOGY. Shiv Pillai Ragon Institute of MGH, MIT and Harvard
TRANSPLANT IMMUNOLOGY Shiv Pillai Ragon Institute of MGH, MIT and Harvard Outline MHC / HLA Direct vs indirect allorecognition Alloreactive cells: where do they come from? Rejection and Immunosuppression
More informationWhat is the Best Induction Immunosuppression Regimen in Kidney Transplantation? Richard Borrows: Queen Elizabeth Hospital Birmingham
What is the Best Induction Immunosuppression Regimen in Kidney Transplantation? Richard Borrows: Queen Elizabeth Hospital Birmingham SYMPHONY Study Ekberg et al. NEJM 2008 Excluded: DCD kidneys; CIT>30hours;
More informationInterstitial Inflammation
Interstitial Inflammation Currently considered to be T cell-mediated process Plasma cell rich acute rejection often associated with AMR Preliminary data suggests that interstitial follicular helper T cells
More informationChronic Active TCMR: clinical implications
Chronic Active TCMR: i, iatr, i-ifta, and the clinical implications Roslyn B. Mannon, M.D. Professor of Medicine, Division of Nephrology Professor of Surgery, Division of Transplantation Director of Research,
More informationBiopsy Features of Kidney Allograft Rejection Banff B. Ivanyi, MD Department of Pathology, University of Szeged, Szeged, Hungary
Biopsy Features of Kidney Allograft Rejection Banff 2017 B. Ivanyi, MD Department of Pathology, University of Szeged, Szeged, Hungary Treatment of allograft dysfunction should rely on the biopsy findings
More informationInnovation In Transplantation:
Innovation In Transplantation: Improving outcomes Thomas C. Pearson Department of Surgery Emory Transplant Center CHOA Symposium October 22, 2016 Disclosures Belatacept preclinical and clinical trial were
More informationThe Banff Classification for Diagnosis of Renal Allograft Rejection: Updates from the 2017 Banff Conference
The Banff Classification for Diagnosis of Renal Allograft Rejection: Updates from the 2017 Banff Conference Mark Haas Cedars-Sinai Medical Center Los Angeles, California, USA Statement of Disclosure Mark
More informationStatement of Disclosure
Statement of Disclosure Mark Haas serves as a paid consultant on pathology adjudication committees for two industry-sponsored clinical trials: Shire ViroPharma Treatment of Acute ABMR AstraZeneca Treatment
More informationDiagnosis and Management of Acute and Chronic Humoral Rejection. Lars Pape
Diagnosis and Management of Acute and Chronic Humoral Rejection Lars Pape Immunosuppression Acute rejection Chronic rejection Side effects Infections Nephrotoxicity Adult population Nearly all late rejection-related
More informationTolerance Induction in Transplantation
Tolerance Induction in Transplantation Reza F. Saidi, MD, FACS, FICS Assistant Professor of Surgery Division of Organ Transplantation Department of Surgery University of Massachusetts Medical School Percent
More informationKidney Summary. Mark Haas Cedars-Sinai Medical Center Los Angeles, California, USA
Kidney Summary Mark Haas Cedars-Sinai Medical Center Los Angeles, California, USA Key Issues to Address re: the Classification 1. Incorporation of i-ifta + tubulitis into the TCMR classification - Defining
More informationLiterature Review Transplantation
Literature Review 2010- Transplantation Alexander Wiseman, M.D. Associate Professor, Division of Renal Diseases and Hypertension Medical Director, Kidney and Pancreas Transplant Programs University of
More informationSince the first Banff meeting in 1991, the diagnosis and
CLINICAL AND TRANSLATIONAL RESEARCH Acute Cellular Rejection: Impact of Donor-Specific Antibodies and C4d Michelle Willicombe, 1,5 Candice Roufosse, 2 Paul Brookes, 3 Adam G. McLean 1, Jack Galliford,
More informationLiterature Review: Transplantation July 2010-June 2011
Literature Review: Transplantation July 2010-June 2011 James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Kidney Transplant Top 10 List: July Kidney
More informationBetter than Google- Click on Immunosuppression Renal Transplant. David Landsberg Oct
Better than Google- Click on Immunosuppression Renal Transplant David Landsberg Oct 3 2008 OUTLINE History of Immunosuppression Trends in Immunosupression FK vs CYA Steroid Minimization CNI Avoidance Sirolimus
More informationReview of Rituximab and renal transplantation. Dr.E Nemati. Professor of Nephrology
Review of Rituximab and renal transplantation Dr.E Nemati Professor of Nephrology Introductio n Rituximab is a chimeric anti-cd20 monoclonal antibody. The CD20 antigen is a transmembrane nonglycosylated
More informationPost-Transplant Monitoring for the Development of Anti-Donor HLA Antibodies
Post-Transplant Monitoring for the Development of Anti-Donor HLA Antibodies Lorita M Rebellato, Ph.D., D (ABHI) Associate Professor Department of Pathology The Brody School of Medicine at ECU Scientific
More informationOBJECTIVES. Phases of Transplantation and Immunosuppression
Transplant and Immunosuppression: Texas Transplant Center April 29, 2017 Regina L. Ramirez, Pharm.D., BCPS PGY1 Pharmacy Residency Program Director Clinical Practice Specialist Solid Organ Transplant and
More informationBK virus infection in renal transplant recipients: single centre experience. Dr Wong Lok Yan Ivy
BK virus infection in renal transplant recipients: single centre experience Dr Wong Lok Yan Ivy Background BK virus nephropathy (BKVN) has emerged as an important cause of renal graft dysfunction in recent
More informationEfficacy and Safety of Thymoglobulin and Basiliximab in Kidney Transplant Patients at High Risk for Acute Rejection and Delayed Graft Function
ArtIcle Efficacy and Safety of Thymoglobulin and Basiliximab in Kidney Transplant Patients at High Risk for Acute Rejection and Delayed Graft Function Guodong Chen, 1 Jingli Gu, 2 Jiang Qiu, 1 Changxi
More informationCURRICULUM VITAE July 5, Name Chang-Kwon Oh. Date of Birth August 15, 1961
CURRICULUM VITAE July 5, 2014 Name Chang-Kwon Oh Date of Birth August 15, 1961 Present Academic & Hospital Appointment Professor, Department of Surgery Ajou University, School of Medicine Chief, Department
More informationWhy Do We Need New Immunosuppressive Agents
Why Do We Need New Immunosuppressive Agents 1 Reducing acute rejection rates has not transplanted into better long-term graft survival Incidence of early acute rejection episodes by era Relative risk for
More informationRisk Factors in Long Term Immunosuppressive Use and Advagraf. Daniel Serón Nephrology department Hospital Universitari Vall d Hebron
Risk Factors in Long Term Immunosuppressive Use and Advagraf Daniel Serón Nephrology department Hospital Universitari Vall d Hebron Progressive well defined diseases ABMR GN Polyoma Non-specific Findings
More informationControversies in Renal Transplantation. The Controversial Questions. Patrick M. Klem, PharmD, BCPS University of Colorado Hospital
Controversies in Renal Transplantation Patrick M. Klem, PharmD, BCPS University of Colorado Hospital The Controversial Questions Are newer immunosuppressants improving patient outcomes? Are corticosteroids
More informationVictims of success: Do we still need clinical trials? Robert S. Gaston, MD CTI Clinical Trials and Consulting University of Alabama at Birmingham
Victims of success: Do we still need clinical trials? Robert S. Gaston, MD CTI Clinical Trials and Consulting University of Alabama at Birmingham Disclosure Employee: CTI Clinical Trials and Consulting
More informationInduction of donor-specific hyporesponsiveness after renal. transplantation. Long term follow-up
Induction of donor-specific hyporesponsiveness after renal transplantation. Long term follow-up Marc Lúcia, Oriol Bestard, Marcel la Franquesa, Josep M Cruzado, Montse Gomà, Núria Bolaños, Gema Cerezo,
More informationSteroid Minimization: Great Idea or Silly Move?
Steroid Minimization: Great Idea or Silly Move? Disclosures I have financial relationship(s) within the last 12 months relevant to my presentation with: Astellas Grants ** Bristol Myers Squibb Grants,
More informationSCORING OF i-ifta: POTENTIAL RULES & ROLE IN CHRONIC TCMR
SCORING OF i-ifta: POTENTIAL RULES & ROLE IN CHRONIC TCMR Parmjeet Randhawa, MD Professor of Pathology The Thomas E Starzl Transplantation Institute University of Pittsburgh . I HAVE NO CONFLICTS OR FINANCIAL
More informationIMMUNOBIOLOGY OF TRANSPLANTATION. Wasim Dar
IMMUNOBIOLOGY OF TRANSPLANTATION Wasim Dar Immunobiology of Transplantation Overview Transplantation: A complex immunologic process Contributions Innate Immunity Adaptive immunity T Cells B Cells HLA Consequences
More informationTransplantation in Australia and New Zealand
Transplantation in Australia and New Zealand Matthew D. Jose MBBS (Adel), FRACP, FASN, PhD (Monash), AFRACMA Professor of Medicine, UTAS Renal Physician, Royal Hobart Hospital Overview CKD in Australia
More informationThe new Banff vision of the role of HLA antibodies in organ transplantation: Improving diagnostic system and design of clinical trials
The new Banff vision of the role of HLA antibodies in organ transplantation: Improving diagnostic system and design of clinical trials Carmen Lefaucheur 1 2 Banff 2015: Integration of HLA-Ab for improving
More informationLiver Transplant Immunosuppression
Liver Transplant Immunosuppression Michael Daily, MD, MS, FACS Surgical Director, Kidney and Pancreas Transplantation University of Kentucky Medical Center Disclosures No financial disclosures I will be
More informationImpact of Subclinical Rejection on Transplantation
Trends in Transplantation 2007;1:56-60 Impact of Subclinical Rejection on Transplantation David N. Rush for the Winnipeg Transplant Group Transplant Manitoba Adult Kidney Program, University of Manitoba,
More informationKidney Transplant. November 4 th, 2016
Kidney Transplant November 4 th, 2016 Brad West, MD, FACP Medical Director of Transplant Services, Memorial Medical Center Chairman Department of Nephrology, Springfield Clinic 1 Adjusted survival: 1993-1997
More informationChronic Kidney Disease (CKD) Stages. CHRONIC KIDNEY DISEASE Treatment Options. Incident counts & adjusted rates, by primary diagnosis Figure 2.
Chronic Kidney Disease (CKD) Stages Stage 1 GFR > 90 (evidence of renal disease) Stage 2 GFR 60-89 Stage 3 GFR 30-59 Stage 4 GFR 15-29 Stage 5 GFR
More informationImmunosuppressants. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia
Immunosuppressants Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Immunosuppressive Agents Very useful in minimizing the occurrence of exaggerated or inappropriate
More informationDonor-derived Cell-free DNA Improves DSA-informed Diagnosis of ABMR in Kidney Transplant Patients
Donor-derived Cell-free DNA Improves DSA-informed Diagnosis of ABMR in Kidney Transplant Patients Stanley C. Jordan, MD Director, Division of Nephrology Medical Director, Kidney Transplant Program Medical
More informationFIT Board Review Corner March 2016
FIT Board Review Corner March 2016 Welcome to the FIT Board Review Corner, prepared by Sarah Spriet, DO, and Tammy Peng, MD, senior and junior representatives of ACAAI's Fellows-In-Training (FITs) to the
More informationImmunosuppressant medicines have allowed patients
48 Clinical Pharmacist February 2010 Vol 2 Patients who tolerate a transplanted organ without the need for pharmacological intervention are few and far between. Several immunosuppressants can be used to
More informationBelatacept: An Opportunity to Personalize Immunosuppression? Andrew Adams MD/PhD Emory Transplant Center
Belatacept: An Opportunity to Personalize Immunosuppression? Andrew Adams MD/PhD Emory Transplant Center Disclosure Research Funding from BMS. Learning Objectives -Define belatacept-resistant rejection
More informationWhy we need a new paradigm in immunosuppression USHERING A NEW ERA OF IMMUNOSUPPRESSION. Causes of death and graft loss after kidney transplantation
USHERING A NEW ERA OF IMMUNOSUPPRESSION Flavio Vincenti 45 35 AR 3 (%) 25 15 5 35.7 Why we need a new paradigm in immunosuppression Incidence of early acute rejection episodes ( 6 months) 43.7 27.4 17.9
More informationDSA Positive and then To biopsy or not?
DSA Positive and then To biopsy or not? Banff SCT 2017 29 March 2017 Peter Nickerson, MD, FRCPC, FCAHS Flynn Family Chair in Renal Transplantation Professor of Internal Medicine and Immunology Relevant
More informationPathology of Kidney Allograft Dysfunction. B. Ivanyi, MD Department of Pathology, University of Szeged, Szeged, Hungary
Pathology of Kidney Allograft Dysfunction B. Ivanyi, MD Department of Pathology, University of Szeged, Szeged, Hungary The gold standard for exploration of the cause of an allograft dysfunction is to perform
More informationAMR in Liver Transplantation: Incidence
AMR in Liver Transplantation: Incidence Primary AMR 1/3 to 1/2 of ABO-incompatible transplants Uncommon with ABO-compatible transplant Secondary AMR Unknown incidence: rarely tested Why is AMR uncommon
More informationAcute renal failure (ARF) in the transplanted kidney represents a
Acute Renal Failure in the Transplanted Kidney Kim Solez Lorraine C. Racusen Acute renal failure (ARF) in the transplanted kidney represents a high-stakes area of nephrology and of transplantation practice.
More informationBanff Vascularized Composite Allotransplantation
Banff Vascularized Composite Allotransplantation Linda C. Cendales, M.D. Associate Professor of Surgery Duke Health Scholar Director, Vascularized Composite Allotransplantation Duke University Medical
More informationImmunosuppressive therapy for graft-versus-host disease. Mohamad Mohty Institut Paoli-Calmettes, Marseille
Immunosuppressive therapy for graft-versus-host disease Mohamad Mohty Institut Paoli-Calmettes, Marseille Survival according to GVHD grade (Joint SFGM-TC, DFCI and IBMTR data; N=607) Cahn et al., Blood
More informationIntruduction PSI MODE OF ACTION AND PHARMACOKINETICS
Multidisciplinary Insights on Clinical Guidance for the Use of Proliferation Signal Inhibitors in Heart Transplantation Andreas Zuckermann, MD et al. Department of Cardio-Thoracic Surgery, Medical University
More informationEndothelitis in cardiac allograft biopsy specimens: Possible relationship to antibody-mediated rejection
http://www.jhltonline.org ORIGINAL CLINICAL SCIENCE Endothelitis in cardiac allograft biopsy specimens: Possible relationship to antibody-mediated rejection Fabio Tavora, MD, a Raghava Munivenkatappa,
More informationBanff 2003 Meeting Report: New Diagnostic Insights and Standards
American Journal of Transplantation 2004; 4: 1562 1566 Blackwell Munksgaard Meeting Report Copyright C Blackwell Munksgaard 2004 doi: 10.1111/j.1600-6143.2004.00585.x Banff 2003 Meeting Report: New Diagnostic
More informationThe transcriptome of the renal transplant biopsy: the lessons. Philip F Halloran
The transcriptome of the renal transplant biopsy: the lessons Philip F Halloran Alberta Transplant Applied Genomics Centre April 27 th 2009 Congratulations on your 50 th anniversary ATAGC Learning objectives:
More informationKidney transplantation 2016: current status and potential challenges
Kidney transplantation 2016: current status and potential challenges 15/12/2016 BVN-SBN : State-of-the-Art on Kidney Transplantation Patrick Peeters Ghent University Hospital, Belgium Challenges in 2016
More informationConsidering the early proactive switch from a CNI to an mtor-inhibitor (Case: Male, age 34) Josep M. Campistol
Considering the early proactive switch from a CNI to an mtor-inhibitor (Case: Male, age 34) Josep M. Campistol Patient details Name DOB ESRD Other history Mr. B.I.B. 12 January 1975 (34yo) Membranous GN
More informationSELECTED ABSTRACTS. All (n) % 3-year GS 88% 82% 86% 85% 88% 80% % 3-year DC-GS 95% 87% 94% 89% 96% 80%
SELECTED ABSTRACTS The following are summaries of selected posters presented at the American Transplant Congress on May 5 9, 2007, in San Humar A, Gillingham KJ, Payne WD, et al. Review of >1000 kidney
More informationAPHERESIS FOR DESENSITIZATION OF NON-RENAL TRANSPLANTS
APHERESIS FOR DESENSITIZATION OF NON-RENAL TRANSPLANTS GOW AREPALLY, MD MEDICAL DIRECTOR DUKE THERAPEUTIC APHERESIS SERVICE ASSOCIATE PROFESSOR, MEDICINE AMERICAN SOCIETY FOR APHERESIS MAY 25 TH 2013 OVERVIEW
More informationIncidence of Rejection in Renal Transplant Surgery in the LVHN Population Leading to Graft Failure: 6 Year Review
Incidence of Rejection in Renal Transplant Surgery in the LVHN Population Leading to Graft Failure: 6 Year Review Jessica Ludolph 1 Lynsey Biondi, MD 1,2 and Michael Moritz, MD 1,2 1 Department of Surgery,
More informationShould red cells be matched for transfusions to patients listed for renal transplantation?
Should red cells be matched for transfusions to patients listed for renal transplantation? Dr M.Willicombe Imperial College Renal and Transplant Centre, Hammersmith Hospital Should red cells be matched
More informationHeart Transplant: State of the Art. Dr Nick Banner
Heart Transplant: State of the Art Dr Nick Banner Heart Transplantation What is achieved Current challenges Donor scarcity More complex recipients Long-term limitations Non-specific Pharmacological Immunosuppression
More informationLong-term prognosis of BK virus-associated nephropathy in kidney transplant recipients
Original Article Kidney Res Clin Pract 37:167-173, 2018(2) pissn: 2211-9132 eissn: 2211-9140 https://doi.org/10.23876/j.krcp.2018.37.2.167 KIDNEY RESEARCH AND CLINICAL PRACTICE Long-term prognosis of BK
More informationIMMUNOSUPPRESSIVE THERAPY Overview. Desensitization
IMMUNOSUPPRESSIVE THERAPY Overview Two types of immune responses to allografts: Cellular response: foreign antigen recognition activate antigen-specific lymphocytes (T-cells) o Key mediator: T-cells o
More informationSolid Organ Transplantation 1. Chapter 55. Solid Organ Transplant, Self-Assessment Questions
Solid Organ Transplantation 1 Chapter 55. Solid Organ Transplant, Self-Assessment Questions Questions 1 to 9 are related to the following case: A 38-year-old white man is scheduled to receive a living-unrelated
More informationImmunology Basics Relevant to Cancer Immunotherapy: T Cell Activation, Costimulation, and Effector T Cells
Immunology Basics Relevant to Cancer Immunotherapy: T Cell Activation, Costimulation, and Effector T Cells Andrew H. Lichtman, M.D. Ph.D. Department of Pathology Brigham and Women s Hospital and Harvard
More information3/6/2017. Treatment of Detected Antibodies. I have financial relationship(s) with: Thoratec/St. Jude/Abbott Consultant CareDx Consultant/Speaker
Treatment of Detected Antibodies Sean Pinney, MD Director, Advanced Heart Failure & Transplantation Mount Sinai Hospital New York, NY Sean Pinney, MD Associate Professor of Medicine Icahn School of Medicine
More informationDate: 23 June Context and policy issues:
Title: Basiliximab for Immunosuppression During a Calcineurin Inhibitor Holiday in Renal Transplant Patients with Acute Renal Dysfunction: Guidelines for Use and a Clinical and Cost-Effectiveness Review
More informationCase Report Beneficial Effect of Conversion to Belatacept in Kidney-Transplant Patients with a Low Glomerular-Filtration Rate
Case Reports in Transplantation, Article ID 190516, 4 pages http://dx.doi.org/10.1155/2014/190516 Case Report Beneficial Effect of Conversion to Belatacept in Kidney-Transplant Patients with a Low Glomerular-Filtration
More informationEmerging Drug List EVEROLIMUS
Generic (Trade Name): Manufacturer: Everolimus (Certican ) Novartis Pharmaceuticals NO. 57 MAY 2004 Indication: Current Regulatory Status: Description: Current Treatment: Cost: Evidence: For use with cyclosporine
More informationRobert B. Colvin, M.D. Department of Pathology Massachusetts General Hospital Harvard Medical School
Harvard-MIT Division of Health Sciences and Technology HST.035: Principle and Practice of Human Pathology Dr. Robert B. Colvin Transplantation: Friendly organs in a hostile environment Robert B. Colvin,
More informationKidney transplantation is the kidney replacement
Transplant Immunology and Immunosuppression: Core Curriculum 2015 Kidney transplantation is the kidney replacement therapy of choice for patients with kidney failure as long as there are no comorbid conditions
More informationDesensitization in Kidney Transplant. James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver
Desensitization in Kidney Transplant James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Organ Shortage Currently there are >90,000 patients on the kidney
More informationMonitoring of human uterus transplantation with cervical biopsies - a provisional scoring system for rejection. Johan Mölne
Monitoring of human uterus transplantation with cervical biopsies - a provisional scoring system for rejection. Johan Mölne Department of Pathology and Genetics, Sahlgrenska Academy, University of Gothenburg,
More informationTransplantation. Immunology Unit College of Medicine King Saud University
Transplantation Immunology Unit College of Medicine King Saud University Objectives To understand the diversity among human leukocyte antigens (HLA) or major histocompatibility complex (MHC) To know the
More informationRecognition and Treatment of Chronic Allograft Dysfunction
Recognition and Treatment of Chronic Allograft Dysfunction Alexander Wiseman, M.D. Associate Professor, Division of Renal Diseases and Hypertension Medical Director, Kidney and Pancreas Transplant Programs
More informationThe classification and treatment of antibody-mediated renal allograft injury: Where do we stand?
http://www.kidney-international.org 2007 International Society of Nephrology see original article on page 24 he classification and treatment of antibody-mediated renal allograft injury: Where do we stand?
More informationChronic Kidney Disease & Transplantation. Paediatrics : 2004 FRACP
Chronic Kidney Disease & Transplantation Paediatrics : 2004 FRACP ANZDATA Registry Mode of First Treatment - Paediatric 14 12 10 8 6 4 2 0 0-4 y 5-9 y 10-14 y 15-19 y Hospital CAPD Hospital HD Hospital
More informationDr. Yi-chi M. Kong August 8, 2001 Benjamini. Ch. 19, Pgs Page 1 of 10 TRANSPLANTATION
Benjamini. Ch. 19, Pgs 379-399 Page 1 of 10 TRANSPLANTATION I. KINDS OF GRAFTS II. RELATIONSHIPS BETWEEN DONOR AND RECIPIENT Benjamini. Ch. 19, Pgs 379-399 Page 2 of 10 II.GRAFT REJECTION IS IMMUNOLOGIC
More informationHLA Part II: My Patient Has DSA, Now What?
2017 CST-Astellas Canadian Transplant Fellows Symposium HLA Part II: My Patient Has DSA, Now What? James Lan, MD, FRCPC, D(ABHI) Dr. Lan completed his nephrology training at the University of British Columbia.
More informationThe diffuse extent of peritubular capillaritis in renal allograft rejection is an independent risk factor for graft loss
http://www.kidney-international.org 2015 International Society of Nephrology see commentary on page 218 The diffuse extent of peritubular capillaritis in renal allograft rejection is an independent risk
More informationPathology of Kidney Allograft Dysfunction. B. Ivanyi, MD Department of Pathology, University of Szeged, Szeged, Hungary
Pathology of Kidney Allograft Dysfunction B. Ivanyi, MD Department of Pathology, University of Szeged, Szeged, Hungary The renal biopsy is a powerful tool in the diagnostic evaluation of allograft dysfunction
More informationHistopathological evaluation of renal allograft biopsies in Nepal: interpretation and significance
Nepal Medical Association Building Exhibition Road, Kathmandu Journal of Pathology of Nepal (2012) Vol. 2, 172-179 Association of Clinical Pathologist of Nepal-2010 Journal of PATHOLOGY of Nepal www.acpnepal.com
More informationReduced graft function (with or without dialysis) vs immediate graft function a comparison of long-term renal allograft survival
Nephrol Dial Transplant (2006) 21: 2270 2274 doi:10.1093/ndt/gfl103 Advance Access publication 22 May 2006 Original Article Reduced graft function (with or without dialysis) vs immediate graft function
More informationE possibile creare un ambiente tollerogenico dopo il trapianto d organo utilizzando cellule staminali come se fossero farmaci?
E possibile creare un ambiente tollerogenico dopo il trapianto d organo utilizzando cellule staminali come se fossero farmaci? Giuseppe Remuzzi 1 Infections & Transplantation Varese, 18 maggio 2017 LONG
More informationAntibody Mediated Rejection (AMR) in LUNG TRANSPLANT Recipients
Antibody Mediated Rejection (AMR) in LUNG TRANSPLANT Recipients Lorriana Leard, MD UCSF Transplant Pulmonologist Associate Professor of Clinical Medicine Vice Chief of Clinical Activities Pulmonary, Critical
More informationFuture Webinars. Handouts 18/09/ Program-Handouts.aspx
Transplant Webinar Series: Ep. 9 Bio for Post-Transplant Immune Injury Future Webinars Link to register: https://immucor.webinato.com/register All Content 215 Immucor, Inc. Handouts http://www.immucor.com/en-us/pages/educational-
More informationResearch Article The Diagnostic Value of Transcription Factors T-bet/GATA3 Ratio in Predicting Antibody-Mediated Rejection
Clinical and Developmental Immunology Volume 2013, Article ID 460316, 6 pages http://dx.doi.org/10.1155/2013/460316 Research Article The Diagnostic Value of Transcription Factors T-bet/GATA3 Ratio in Predicting
More informationUtility of protocol kidney biopsies for de novo donor- specific antibodies
Received: 6 June 2017 Revised: 24 July 2017 Accepted: 29 July 2017 DOI: 10.1111/ajt.14466 BRIEF COMMUNICATION Utility of protocol kidney biopsies for de novo donor- specific antibodies Sandesh Parajuli
More informationTransplant Webinar Series: Ep. 9 Biomarkers for Post-Transplant Immune Injury
Transplant Webinar Series: Ep. 9 Biomarkers for Post-Transplant Immune Injury Future Webinars Link to register: https://immucor.webinato.com/register All Content 2015 Immucor, Inc. Handouts http://www.immucor.com/en-us/pages/educational-
More informationTransplantation: Year in Review
Transplantation: Year in Review Alexander Wiseman, MD Medical Director, Kidney and Pancreas Transplant Program Associate Professor, Division of Renal Diseases and Hypertension University of Colorado Outline:
More informationREACH Risk Evaluation to Achieve Cardiovascular Health
Dyslipidemia and transplantation History: An 8-year-old boy presented with generalized edema and hypertension. A renal biopsy confirmed a diagnosis of focal segmental glomerulosclerosis (FSGS). After his
More information1. Discuss the basic pathophysiology of end-stage liver and kidney failure.
TRANSPLANT SURGERY ROTATION (PGY1, 2) A. Medical Knowledge Goal: The resident will achieve a detailed knowledge of the evaluation and treatment of a variety of disease processes. The resident will be exposed
More informationLe Rejet Humoral Chronique en 2010: Histoire naturelle et problématiques
Le Rejet Humoral Chronique en 2010: Histoire naturelle et problématiques CAMR in 2010: natural history and perspectives Alexandre Loupy 1 Introduction 2 CAMR: the missing link 3 Natural history of CAMR
More informationMECHANISMS OF CELLULAR REJECTION IN ORGAN TRANSPLANTATION AN OVERVIEW
MECHANISMS OF CELLULAR REJECTION IN ORGAN TRANSPLANTATION AN OVERVIEW YVON LEBRANCHU Service Néphrologie et Immunologie Clinique CHU TOURS ANTIGEN PRESENTING CELL CD4 + T CELL CYTOKINE PRODUCTION CLONAL
More informationSerum samples from recipients were obtained within 48 hours before transplantation. Pre-transplant
SDC, Patients and Methods Complement-dependent lymphocytotoxic crossmatch test () Serum samples from recipients were obtained within 48 hours before transplantation. Pre-transplant donor-specific CXM was
More informationThe Histology of Kidney Transplant Failure: A Long-Term Follow-Up Study
CLINICAL AND TRANSLATIONAL RESEARCH The Histology of Kidney Transplant Failure: A Long-Term Follow-Up Study Maarten Naesens, 1,2,6 Dirk R.J. Kuypers, 1,2 Katrien De Vusser, 1,2 Pieter Evenepoel, 1,2 Kathleen
More information