Background: There is unmet need for non-invasive immunomonitoring to improve diagnosis and treatment of acute rejection in vascularized composite allotransplantation (VCA). Circulating matrix metalloproteinase 3 (MMP3) was described as a candidate non-invasive biomarker to predict treatment response to acute rejection in clinical VCA. However, larger validation studies are yet to be reported to allow for more definitive conclusions.Methods: We retrospectively measured MMP3 levels using ELISA in a total of 140 longitudinal serum samples from six internal and three external face transplant recipients, as well as three internal and seven external upper extremity transplant recipients. The control groups comprised serum samples from 36 kidney transplant recipients, 14 healthy controls, and 38 patients with autoimmune skin disease. A linear mixed model was used to study the effect of rejection state (pre-transplant, no-rejection, non-severe rejection (NSR), and severe rejection) on MMP3 levels.Results: In VCA, MMP3 levels increased significantly (p < 0.001) between pre- and post-transplant no-rejection states. A further increase occurred during severe rejection (p < 0.001), while there was no difference in MMP3 levels between non-severe and no-rejection episodes. A threshold of 5-fold increase from pre-transplant levels could discriminate severe from NSR with 76% sensitivity and 81% specificity (AUC = 0.79, 95% CI = 0.65–0.92, p < 0.001). In kidney transplantation, the MMP3 levels were significantly (p < 0.001) elevated during antibody-mediated rejection but not during T-cell mediated rejection (TCMR) (p = 0.547). MMP3 levels in healthy controls and autoimmune skin disease patients were comparable with either pre-transplant or no-rejection/NSR episodes of VCA patients.Conclusion: The results of this study suggest that serum MMP3 protein is a promising marker for stratifying patients according to severity of rejection, complementary to biopsy findings.
Measurements of graft weight as well as donor kidney and recipient body matching should be recommended as influencing renal function.
Revue française de sciences sociales | octobre-décembre 2014Pêle-Mêle L'injonction au projet chez les jeunes en baccalauréat professionnel : entre soumission et prise en main fragile de son destinThe injunction for a project among young people in vocational baccalaureate : between submission and decision fragile hand of his destiny Einbindung in ein Berufsprojekt ("injonction au projet") bei Abiturienten des beruflichen Zweigs : zwischen Fügsamkeit und fragiler Lenkung des eigenen Schicksals La conminación al proyecto entre los jóvenes bachilleres técnicos : entre sumisión y asunción frágil del propio destino
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Introduction: Long-term kidney function depends on multiple factors. One of the factors that may affect survival and function of kidney graft is the functional mass of the graft. Methods: In order to study whether graft mass may be a determinant outcome after kidney transplantation we investigated the impact of the ratio between donor kidney weight (DKW) in grams and recipient body weight (RBW) in kilograms on serum creatinine values, creatinine clearance (calculated as MDRD) and proteinuria. In addition, a pretransplant biopsy was performed and the histological results graded on the basis of Remuzzi score. Delayed graft function, number of rejection episodes and graft survival were also considered. Donor and recipient data were collected at the time of inclusion and then at each follow-up (3, 6, 12, 24 and 36 months after transplantations). One hundred fifty-four kidneys were weighed immediately before grafting; the donors were 95 males and 59 females, mean age was 49±14 years, and mean body weight was 72±15 Kg while the recipients were 89 males and 65 females, mean age was 50±12 and mean body weight was 64±12 Kg. The mean HLA incompatibility was 3±1. The mean kidney weight was 227±59 g. The delayed graft function rate was 12.5% and 24.3% of patients experienced at least one episode of acute rejection. Results: The random coefficient model that we fitted showed significant lower values of creatinine clearance in patients with DKW/ RBW ratio <3g/kg and between 3 and 4 g/kg compared to those with DKW/RBW ratio > 4 g/kg and this difference was significant in all time points of the follow-up. In addition, there was a significant increase in creatinine clearance values in the patients with DKW/RBW <3 g/kg comparing the third to the first month post-transplantation. Other parameters showed to influence significantly creatinine clearance values such as donor and recipient gender, number of acute rejection episodes and donor age. It is interesting to note that there was a remarkable effect of donor/recipient gender on filtration rate when donor and/or recipient was female, suggesting that gender has an effect which is not only due to kidney weight differences. We showed significantly greater occurrence of proteinuria (defined as >0.5g/24h) and earlier appearance in the recipients with DKW/ RBW ratio <2.5g/kg (Hazard ratio=3.6, p<0.001) by mean of Cox proportional-hazards model analysis. Remuzzi score did not influence the apparition of proteinuria, filtration rate and DGF. The incidence of DGF was influenced by HLA mismatches and recipient/donor gender while it was not influenced by DKW/RBW ratio, which neither influenced graft survival. Conclusion: These data confirm the importance of graft mass on renal function, particularly in the first period after transplantation.
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