ABSTRACT
BACKGROUND: Accumulating evidence suggests that detection of human leukocyte antigen (HLA) antibodies by solid phase Luminex assays predicts renal allograft outcomes. However, several controversies exist regarding the interpretation, reproducibility, impact and financial feasibility of global utilization of this assay in pretransplant assessment. METHODS: We studied short-term patient-centered outcomes, medical standards of care, and financial plausibility of using Luminex-based screening for HLA antibodies in renal allograft recipients compared to outcomes in nontested patients. RESULTS: We included 1808 patients assessed for transplantation from 2011 to 2018. Luminex-tested patients had lower rates of rejection in the first post-transplant week (OR 0.36, P < .001) and lower odds of antibody-mediated rejection in the first 6 months (OR 0.4, P = .004). Forty-four patients with preformed, donor-specific antibodies were transplanted, and everolimus was introduced into our protocols for low-risk patients based on risk stratification by Luminex results. The number of tests needed to be performed to prevent 1 episode of antibody-mediated rejection in the first 6 months was 28 (P = .004), which was financially plausible. CONCLUSIONS: Routine pre-transplant assessment of HLA antibodies using Luminex assays may allow for better patient-centered, short-term graft outcomes and objective tailoring of immunosuppression at a financially plausible, cost-effective rate.
Subject(s)
Antibodies/analysis , Graft Rejection/immunology , HLA Antigens/immunology , Immunologic Tests/methods , Kidney Transplantation/adverse effects , Antibodies/immunology , Cost-Benefit Analysis , Feasibility Studies , Female , Humans , Immunologic Tests/economics , Male , Middle Aged , Preoperative Period , Reproducibility of Results , Transplantation, HomologousABSTRACT
BACKGROUND: Patients with chronic renal disease are susceptible to accelerated vascular calcification and cardiovascular morbidity and mortality. Micro RNAs (miRNAs) have been linked to the pathogenesis of cardiovascular diseases in the general population. AIM: This study was carried out to evaluate the link between miRNA 192 and vascular calcification, pre-existing as well as newly occurring major adverse cardiovascular events, and mortality among hemodialysis patients who are also considered to be potential kidney transplant recipients. METHODS: We screened 64 potential transplant recipients on hemodialysis at our university hospital. Pre-existing overt cardiovascular disease was recorded; new adverse cardiovascular events and all causes of death over an observational period of 5 years were prospectively followed. Vascular calcification was measured in the aorta using computerized tomography scans, and micro RNA 192 was measured. RESULTS: The final study population included 55 patients followed for 63 months. Micro RNA 192 was significantly lower in patients who had preexisting cardiovascular disease (P = .015) as well and in all patients who had experienced any event by the end of the observational period (P = .012). A multiregression analysis model including micro RNA, age, dialysis vintage, intradialytic hypotension, vascular calcification, diabetes, systolic blood pressure, and smoking found the only independently correlating factor to cardiovascular events in this model to be micro RNA (ß = -0.286, P = .05). CONCLUSIONS: MiRNA 192 levels are significantly lower among patients experiencing cardiovascular events while on hemodialysis awaiting kidney transplantation.
Subject(s)
Cardiovascular Diseases/genetics , Kidney Failure, Chronic/genetics , MicroRNAs/metabolism , Vascular Calcification/genetics , Waiting Lists/mortality , Adult , Cardiovascular Diseases/mortality , Female , Follow-Up Studies , Humans , Kidney/physiopathology , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Kidney Transplantation , Male , Middle Aged , Renal Dialysis/mortality , Vascular Calcification/mortalityABSTRACT
OBJECTIVE: The aim of the present study was to assess the effect of metabolic syndrome (MetS) and insulin resistance comorbidity on the carotid intima-media thickness (IMT) in systemic lupus erythematosus (SLE) patients and their relationship to clinical manifestations, disease activity, and damage. METHODS: The study included 92 SLE patients (mean age 30.18 ± 8.27 years) and 30 matched controls. Disease activity and damage were assessed by the SLEDAI and SLICC indices, respectively. The Health Assessment Questionnaire II (HAQII) and Quality of Life (QoL) index were evaluated in the patients. Levels of insulin, glucose, and creatinine and the lipid profile were measured in patients and controls. Insulin sensitivity was estimated using the homeostatic model assessment index (HOMA-B) for beta cell function and (HOMA-IR) for peripheral tissue insulin resistance. The carotid IMT was measured by ultrasonography. RESULTS: The SLE patients had high HOMA-IR and HOMA-B. The IMT was significantly increased (0.82± 0.29 mm) compared to the controls (0.45± 0.2 mm).The HOMA-IR, SLEDAI, SLICC, HAQII, and IMT were significantly higher and the QoL lower in those with MetS (n = 34) compared to those without (n = 58), while the HOMAB was comparable. There was a significant correlation between the IMT and the SLEDAI, SLICC, and WHR. CONCLUSION: Insulin sensitivity and IMT are altered in SLE patients, especially those with MetS comorbidity with an associated increase in disease activity and damage. Effective management of MetS would help control SLE activity, damage, and the future development of cardiovascular events especially in the absence of symptoms of cardiovascular disease.
