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  1. Article ; Online: Borderline rejection: To treat or not to treat?

    Palmisano, Alessandra / D'Angelo, Marta / Gandolfini, Ilaria / Delsante, Marco / Rossi, Giovanni Maria / Gentile, Micaela / Fiaccadori, Enrico / Cravedi, Paolo / Maggiore, Umberto

    Transplant immunology

    2024  , Page(s) 102047

    Abstract: Introduction: It is unclear whether kidney transplant recipients with a biopsy diagnosis as a "borderline" acute T-cell mediated rejection (TCMR) requires the treatment with intravenous (iv) steroids pulse plus/minus intensification of the maintenance ... ...

    Abstract Introduction: It is unclear whether kidney transplant recipients with a biopsy diagnosis as a "borderline" acute T-cell mediated rejection (TCMR) requires the treatment with intravenous (iv) steroids pulse plus/minus intensification of the maintenance therapy (TRT) in comparison with the simple clinical follow-up (F-UP).
    Methods: We retrospectively followed a consecutive series of kidney transplant recipients diagnosed with a borderline acute TCMR at biopsy by surveillance or clinical indication for 12 months and compared TRT and F-UP groups. We evaluated trends in renal function by measuring estimated glomerular filtration rate (eGFR) using multiple regression models. Repeated eGFR measures (REML) were adjusted for potential confounding factors for 12 months. The difference in 12-month eGFR values were observed in the TRT vs F-UP groups, type of biopsy, as well as the surveillance vs. clinical outcomes.
    Results: Out of 59 included patients, 37% of them were in the TRT group and remaining 63% in the F-UP group. As expected, the TRT group had, at the time of biopsy, lower eGFR value of 39.0 ml/min/m2 [16.5] in comparison to 49.6 [19.6] ml/min/m
    Conclusion: Our preliminary study supports the indication for the treatment of acute borderline TCMR only in cases with biopsies confirmed by clinical indication.
    Language English
    Publishing date 2024-04-17
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1160846-8
    ISSN 1878-5492 ; 0966-3274
    ISSN (online) 1878-5492
    ISSN 0966-3274
    DOI 10.1016/j.trim.2024.102047
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  2. Article: Detecting, preventing and treating non-adherence to immunosuppression after kidney transplantation.

    Gandolfini, Ilaria / Palmisano, Alessandra / Fiaccadori, Enrico / Cravedi, Paolo / Maggiore, Umberto

    Clinical kidney journal

    2022  Volume 15, Issue 7, Page(s) 1253–1274

    Abstract: Medication non-adherence (MNA) is a major issue in kidney transplantation and it is associated with increased risk of rejection, allograft loss, patients' death and higher healthcare costs. Despite its crucial importance, it is still unclear what are the ...

    Abstract Medication non-adherence (MNA) is a major issue in kidney transplantation and it is associated with increased risk of rejection, allograft loss, patients' death and higher healthcare costs. Despite its crucial importance, it is still unclear what are the best strategies to diagnose, prevent and treat MNA. MNA can be intentional (deliberate refusal to take the medication as prescribed) or unintentional (non-deliberate missing the prescribed medication). Its diagnosis may rely on direct methods, aiming at measuring drug ingestions, or indirect methods that analyse the habits of patients to adhere to correct drug dose (taking adherence) and interval (time adherence). Identifying individual risk factors for MNA may provide the basis for a personalized approach to the treatment of MNA. Randomized control trials performed so far have tested a combination of strategies, such as enhancing medication adherence through the commitment of healthcare personnel involved in drug distribution, the use of electronic reminders, therapy simplification or various multidisciplinary approaches to maximize the correction of individual risk factors. Although most of these approaches reduced MNA in the short-term, the long-term effects on MNA and, more importantly, on clinical outcomes remain unclear. In this review, we provide a critical appraisal of traditional and newer methods for detecting, preventing and treating non-adherence to immunosuppression after kidney transplantation from the perspective of the practising physician.
    Language English
    Publishing date 2022-01-14
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2655800-2
    ISSN 2048-8513 ; 2048-8505
    ISSN (online) 2048-8513
    ISSN 2048-8505
    DOI 10.1093/ckj/sfac017
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  3. Article ; Online: Targeted-release budesonide in recurrent IgA nephropathy after kidney transplantation.

    Gandolfini, Ilaria / Alibrandi, Sara / Gentile, Micaela / Russo, Luis Sanchez / Fiaccadori, Enrico / Palmisano, Alessandra / Cravedi, Paolo / Maggiore, Umberto

    Kidney international

    2023  Volume 103, Issue 5, Page(s) 995–996

    MeSH term(s) Humans ; Budesonide/therapeutic use ; Glomerulonephritis, IGA/drug therapy ; Kidney Transplantation/adverse effects
    Chemical Substances Budesonide (51333-22-3)
    Language English
    Publishing date 2023-04-21
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 120573-0
    ISSN 1523-1755 ; 0085-2538
    ISSN (online) 1523-1755
    ISSN 0085-2538
    DOI 10.1016/j.kint.2023.02.012
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    Zs.A 797: Show issues Location:
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  4. Article ; Online: Sarcopenic obesity and its relation with muscle quality and mortality in patients on chronic hemodialysis.

    Sabatino, Alice / Avesani, Carla Maria / Regolisti, Giuseppe / Adinolfi, Marianna / Benigno, Giuseppe / Delsante, Marco / Fiaccadori, Enrico / Gandolfini, Ilaria

    Clinical nutrition (Edinburgh, Scotland)

    2023  Volume 42, Issue 8, Page(s) 1359–1368

    Abstract: Background & aims: Sarcopenia is prevalent in patients with end-stage kidney disease (ESKD) on hemodialysis (HD), and is associated with poor outcomes, while obesity may be protective. Sarcopenic obesity is associated with increased frailty, morbidity ... ...

    Abstract Background & aims: Sarcopenia is prevalent in patients with end-stage kidney disease (ESKD) on hemodialysis (HD), and is associated with poor outcomes, while obesity may be protective. Sarcopenic obesity is associated with increased frailty, morbidity and mortality in the general population. Myosteatosis, i.e., muscle fat infiltration, has major effects on muscle strength and physical performance, but is poorly investigated in the nephrology setting. In the present study we aimed to assess the association between sarcopenic obesity, as diagnosed by abdominal CT, and mortality. Moreover, the relationship between myosteatosis, sarcopenic obesity and mortality was also investigated.
    Methods: This is a retrospective study in which ESKD patients on HD submitted to unenhanced abdominal CT for clinical reasons at least 6 months after dialysis initiation were evaluated for sarcopenic obesity and myosteatosis, defined as intermuscular fat area and low attenuation muscle area. Sarcopenic obesity was diagnosed in cases of low abdominal skeletal muscle area and high total fat area. Receiver-operating characteristics (ROC) analysis with Youden index was used to determine the cut-off for high total fat area. Intermuscular fat area and low attenuation muscle area were evaluated by applying the Hounsfield unit of interest (-190; -30, and -29; +29 respectively). Cox regression analysis was used to evaluate the association between predictors and mortality risk.
    Results: We enrolled 212 patients, aged 68.8 (±14.7) years, 65.5% (139/212) male. Median follow-up was 19.7 (interquartile range [IQR] 2.7-35) months. Sarcopenic obesity was diagnosed in 19.8% of patients and was associated with increased mortality (HR: 3.29 (1.72; 6.27), P < 0.001), and with the presence of myosteatosis. Both intermuscular fat area and low attenuation muscle area were associated with increased mortality in adjusted analyses.
    Conclusions: Patients with sarcopenic obesity have increased myosteatosis. Sarcopenic obesity and myosteatosis are associated with increased mortality in patients on HD.
    MeSH term(s) Humans ; Male ; Sarcopenia/complications ; Sarcopenia/epidemiology ; Retrospective Studies ; Renal Dialysis ; Obesity/epidemiology ; Muscle, Skeletal/pathology
    Language English
    Publishing date 2023-06-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 604812-2
    ISSN 1532-1983 ; 0261-5614
    ISSN (online) 1532-1983
    ISSN 0261-5614
    DOI 10.1016/j.clnu.2023.06.032
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  5. Article: Acute Kidney Injury (AKI) before and after Kidney Transplantation: Causes, Medical Approach, and Implications for the Long-Term Outcomes.

    Palmisano, Alessandra / Gandolfini, Ilaria / Delsante, Marco / Cantarelli, Chiara / Fiaccadori, Enrico / Cravedi, Paolo / Maggiore, Umberto

    Journal of clinical medicine

    2021  Volume 10, Issue 7

    Abstract: Acute kidney injury (AKI) is a common finding in kidney donors and recipients. AKI in kidney donor, which increases the risk of delayed graft function (DGF), may not by itself jeopardize the short- and long-term outcome of transplantation. However, some ... ...

    Abstract Acute kidney injury (AKI) is a common finding in kidney donors and recipients. AKI in kidney donor, which increases the risk of delayed graft function (DGF), may not by itself jeopardize the short- and long-term outcome of transplantation. However, some forms of AKI may induce graft rejection, fibrosis, and eventually graft dysfunction. Therefore, various strategies have been proposed to identify conditions at highest risk of AKI-induced DGF, that can be treated by targeting the donor, the recipient, or even the graft itself with the use of perfusion machines. AKI that occurs early post-transplant after a period of initial recovery of graft function may reflect serious and often occult systemic complications that may require prompt intervention to prevent graft loss. AKI that develops long after transplantation is often related to nephrotoxic drug reactions. In symptomatic patients, AKI is usually associated with various systemic medical complications and could represent a risk of mortality. Electronic systems have been developed to alert transplant physicians that AKI has occurred in a transplant recipient during long-term outpatient follow-up. Herein, we will review most recent understandings of pathophysiology, diagnosis, therapeutic approach, and short- and long-term consequences of AKI occurring in both the donor and in the kidney transplant recipient.
    Language English
    Publishing date 2021-04-02
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm10071484
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  6. Article ; Online: Kidney Involvement in COVID-19: Need for Better Definitions.

    Delsante, Marco / Rossi, Giovanni M / Gandolfini, Ilaria / Bagnasco, Serena M / Rosenberg, Avi Z

    Journal of the American Society of Nephrology : JASN

    2020  Volume 31, Issue 9, Page(s) 2224–2225

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Humans ; Kidney ; Pandemics ; Pneumonia, Viral ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-07-09
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1085942-1
    ISSN 1533-3450 ; 1046-6673
    ISSN (online) 1533-3450
    ISSN 1046-6673
    DOI 10.1681/ASN.2020050630
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  7. Article ; Online: Metabolic risk profile in kidney transplant candidates and recipients.

    Piotti, Giovanni / Gandolfini, Ilaria / Palmisano, Alessandra / Maggiore, Umberto

    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

    2018  Volume 34, Issue 3, Page(s) 388–400

    Abstract: Metabolic risk factors of cardiovascular disease such as abnormal glucose regulation, obesity and metabolic syndrome, dyslipidaemia, metabolic bone disease, hyperuricaemia and other less traditional abnormalities are common in both kidney transplant ... ...

    Abstract Metabolic risk factors of cardiovascular disease such as abnormal glucose regulation, obesity and metabolic syndrome, dyslipidaemia, metabolic bone disease, hyperuricaemia and other less traditional abnormalities are common in both kidney transplant candidates and recipients. In kidney transplant candidates, the presence of these risk factors may impede patient access to transplantation by increasing the risk of developing comorbidities while on the waiting list, prolonging the time to wait-listing and, in some patients, eventually jeopardizing their suitability for kidney transplantation or increasing the risk of severe perioperative complications. In transplant recipients, metabolic risk factors may be associated with increased mortality with a functioning graft and with reduced long-term renal graft survival. Although most transplant recipients have no contraindication to the use of drugs that undergo renal excretion, they may be at risk of drug-to-drug pharmacokinetic interactions with anti-rejection medicines. In this review, we have highlighted the main objectives of evaluating the metabolic abnormalities in transplant candidates and recipients, how this evaluation should be carried out in practice and what currently the most valuable treatment strategies are for modifying the associated risks. We conclude that, for every potential transplant candidate, every effort should be made to control metabolic abnormalities causing arterial calcification, which may impede access to transplantation and impair transplant outcome. In transplant recipients, metabolic abnormalities that result from adverse effects of anti-rejection therapy may be effectively controlled by lifestyle changes and judicious use of drugs for the treatment of abnormal glucose metabolism and dyslipidaemia.
    MeSH term(s) Graft Rejection/etiology ; Humans ; Kidney Transplantation/adverse effects ; Metabolic Syndrome/etiology ; Risk Factors ; Transplant Recipients/statistics & numerical data
    Language English
    Publishing date 2018-05-24
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 90594-x
    ISSN 1460-2385 ; 0931-0509
    ISSN (online) 1460-2385
    ISSN 0931-0509
    DOI 10.1093/ndt/gfy151
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  8. Article ; Online: The 3-Step Model of informed consent for living kidney donation: a proposal on behalf of the DESCaRTES Working Group of the European Renal Association.

    Grossi, Alessandra Agnese / Sever, Mehmet Sukru / Hellemans, Rachel / Mariat, Christophe / Crespo, Marta / Watschinger, Bruno / Peruzzi, Licia / Demir, Erol / Velioglu, Arzu / Gandolfini, Ilaria / Oniscu, Gabriel C / Hilbrands, Luuk / Mjoen, Geir

    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

    2023  Volume 38, Issue 7, Page(s) 1613–1622

    Abstract: Living donation challenges the ethical principle of non-maleficence in that it exposes healthy persons to risks for the benefit of someone else. This makes safety, informed consent (IC) and education a priority. Living kidney donation has multiple ... ...

    Abstract Living donation challenges the ethical principle of non-maleficence in that it exposes healthy persons to risks for the benefit of someone else. This makes safety, informed consent (IC) and education a priority. Living kidney donation has multiple benefits for the potential donor, but there are also several known short- and long-term risks. Although complete standardization of IC is likely to be unattainable, studies have emphasized the need for a standardized IC process to enable equitable educational and decision-making prospects for the prevention of inequities across transplant centers. Based on the Three-Talk Model of shared decision-making by Elwyn et al., we propose a model, named 3-Step (S) Model, where each step coincides with the three ideal timings of the process leading the living donor to the decision to pursue living donation: prior to the need for kidney replacement therapy (team talk); at the local nephrology unit or transplant center, with transplant clinicians and surgeons prior to evaluations start (option talk); and throughout evaluation, after having learned about the different aspects of donation, especially if there are second thoughts or doubts (decision talk). Based on the 3-S Model, to deliver conceptual and practical guidance to nephrologists and transplant clinicians, we provide recommendations for standardization of the timing, content, modalities for communicating risks and assessment of understanding prior to donation. The 3-S Model successfully allows an integration between standardization and individualization of IC, enabling a person-centered approach to potential donors. Studies will assess the effectiveness of the 3-S Model in kidney transplant clinical practice.
    MeSH term(s) Humans ; Kidney ; Informed Consent ; Tissue and Organ Harvesting ; Kidney Transplantation/education ; Living Donors
    Language English
    Publishing date 2023-01-27
    Publishing country England
    Document type Journal Article
    ZDB-ID 90594-x
    ISSN 1460-2385 ; 0931-0509
    ISSN (online) 1460-2385
    ISSN 0931-0509
    DOI 10.1093/ndt/gfad022
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  9. Article ; Online: Acute Kidney Injury (AKI) before and after Kidney Transplantation

    Alessandra Palmisano / Ilaria Gandolfini / Marco Delsante / Chiara Cantarelli / Enrico Fiaccadori / Paolo Cravedi / Umberto Maggiore

    Journal of Clinical Medicine, Vol 10, Iss 1484, p

    Causes, Medical Approach, and Implications for the Long-Term Outcomes

    2021  Volume 1484

    Abstract: Acute kidney injury (AKI) is a common finding in kidney donors and recipients. AKI in kidney donor, which increases the risk of delayed graft function (DGF), may not by itself jeopardize the short- and long-term outcome of transplantation. However, some ... ...

    Abstract Acute kidney injury (AKI) is a common finding in kidney donors and recipients. AKI in kidney donor, which increases the risk of delayed graft function (DGF), may not by itself jeopardize the short- and long-term outcome of transplantation. However, some forms of AKI may induce graft rejection, fibrosis, and eventually graft dysfunction. Therefore, various strategies have been proposed to identify conditions at highest risk of AKI-induced DGF, that can be treated by targeting the donor, the recipient, or even the graft itself with the use of perfusion machines. AKI that occurs early post-transplant after a period of initial recovery of graft function may reflect serious and often occult systemic complications that may require prompt intervention to prevent graft loss. AKI that develops long after transplantation is often related to nephrotoxic drug reactions. In symptomatic patients, AKI is usually associated with various systemic medical complications and could represent a risk of mortality. Electronic systems have been developed to alert transplant physicians that AKI has occurred in a transplant recipient during long-term outpatient follow-up. Herein, we will review most recent understandings of pathophysiology, diagnosis, therapeutic approach, and short- and long-term consequences of AKI occurring in both the donor and in the kidney transplant recipient.
    Keywords acute kidney injury ; kidney transplantation ; delayed graft function ; donor selection ; Medicine ; R
    Subject code 610
    Language English
    Publishing date 2021-04-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  10. Article ; Online: Chemotherapy, targeted therapy and immunotherapy: Which drugs can be safely used in the solid organ transplant recipients?

    Maggiore, Umberto / Palmisano, Alessandra / Buti, Sebastiano / Claire Giudice, Giulia / Cattaneo, Dario / Giuliani, Nicola / Fiaccadori, Enrico / Gandolfini, Ilaria / Cravedi, Paolo

    Transplant international : official journal of the European Society for Organ Transplantation

    2021  Volume 34, Issue 12, Page(s) 2442–2458

    Abstract: In solid organ transplant recipients, cancer is associated with worse prognosis than in the general population. Among the causes of increased cancer-associated mortality, are the limitations in selecting the optimal anticancer regimen in solid organ ... ...

    Abstract In solid organ transplant recipients, cancer is associated with worse prognosis than in the general population. Among the causes of increased cancer-associated mortality, are the limitations in selecting the optimal anticancer regimen in solid organ transplant recipients, because of the associated risks of graft toxicity and rejection, drug-to-drug interactions, reduced kidney or liver function, and patient frailty and comorbid conditions. The advent of immunotherapy has generated further challenges, mainly because checkpoint inhibitors increase the risk of rejection, which may have life-threatening consequences in recipients of life-saving organs. In general, there are no safe or unsafe anticancer drugs. Rather, the optimal choice of the anticancer regimen results from a careful risk/benefit assessment, from the awareness of potential pharmacokinetic and pharmacodynamic drug-to-drug interactions, and of the risk of drug overexposure in patients with kidney or liver dysfunction. In this review, we summarize general principles that may help the oncologists and transplant physicians in the multidisciplinary management of recipients of solid organ transplantation with cancer who are candidates for chemotherapy, targeted therapy, or immunotherapy.
    MeSH term(s) Graft Rejection/prevention & control ; Humans ; Immunosuppressive Agents ; Immunotherapy ; Organ Transplantation ; Pharmaceutical Preparations ; Transplant Recipients
    Chemical Substances Immunosuppressive Agents ; Pharmaceutical Preparations
    Language English
    Publishing date 2021-10-28
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 639435-8
    ISSN 1432-2277 ; 0934-0874
    ISSN (online) 1432-2277
    ISSN 0934-0874
    DOI 10.1111/tri.14115
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