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Article: Detecting, preventing and treating non-adherence to immunosuppression after kidney transplantation.

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

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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Zs.A 6587: Show issues

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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 Volume 84, 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 performed by clinical indication.
Language	English
Publishing date	2024-04-18
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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Zs.A 3784: Show issues

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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

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Article ; Online: CXCL9 and CXCL10 as biomarkers of kidney graft inflammation across multiple conditions.

Gandolfini, Ilaria / Mordà, Benedetta / Martinelli, Elene / Delsante, Marco / Rossi, GiovanniMaria / Gentile, Micaela / Alibrandi, Sara / Salvetti, Daniel / Fiaccadori, Enrico / Palmisano, Alessandra / Cravedi, Paolo / Maggiore, Umberto

Clinical transplantation

2024 Volume 38, Issue 5, Page(s) e15324

MeSH term(s)	Humans ; Chemokine CXCL10/blood ; Chemokine CXCL10/metabolism ; Biomarkers/analysis ; Biomarkers/blood ; Kidney Transplantation ; Chemokine CXCL9/blood ; Prognosis ; Graft Rejection/etiology ; Graft Rejection/diagnosis ; Graft Rejection/immunology ; Graft Rejection/blood ; Inflammation/metabolism ; Male ; Female ; Graft Survival ; Middle Aged
Chemical Substances	Chemokine CXCL10 ; Biomarkers ; CXCL10 protein, human ; Chemokine CXCL9 ; CXCL9 protein, human
Language	English
Publishing date	2024-04-28
Publishing country	Denmark
Document type	Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.15324
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Zs.A 2204: Show issues

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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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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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Zs.A 2198: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 329: Show issues

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Article ; Online: Chronic Periaortitis: an Update.

Palmisano, Alessandra / Maritati, Federica / Vaglio, Augusto

Current rheumatology reports

2018 Volume 20, Issue 12, Page(s) 80

Abstract: Purpose of review: We aim to review traditional concepts and recent developments on the nosology, pathophysiology, clinical phenotypes and treatment of chronic periaortitis (CP).: Recent findings: CP is a rare disorder hallmarked by a periaortic ... ...

Abstract	Purpose of review: We aim to review traditional concepts and recent developments on the nosology, pathophysiology, clinical phenotypes and treatment of chronic periaortitis (CP). Recent findings: CP is a rare disorder hallmarked by a periaortic fibro-inflammatory tissue. It can present as an isolated disease, but it can also be associated with other autoimmune and fibro-inflammatory lesions (e.g., fibrosing mediastinitis, sclerosing pancreato-cholangitis) that are part of the spectrum of IgG4-related disease. In a subgroup of patients, it also involves the thoracic aorta (so-called "diffuse periaortitis"), which supports the notion of an inflammatory disorder of large arteries. The pathogenesis of CP is multifactorial: recent studies have elucidated the predisposing role of immunogenetic variants and exposures to environmental agents such as smoking and asbestos. CP is a rare immune-mediated disease that affects the abdominal aorta and the iliac arteries and, in some cases, the thoracic aorta. It may overlap with manifestations of IgG4-related disease, and its treatment comprises glucocorticoids, conventional and biological immunosuppressive agents.
MeSH term(s)	Aorta, Abdominal/immunology ; Aorta, Abdominal/pathology ; Glucocorticoids/therapeutic use ; Humans ; Immunoglobulin G/blood ; Retroperitoneal Fibrosis/diagnosis ; Retroperitoneal Fibrosis/drug therapy ; Retroperitoneal Fibrosis/immunology ; Retroperitoneal Fibrosis/pathology
Chemical Substances	Glucocorticoids ; Immunoglobulin G
Language	English
Publishing date	2018-11-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057357-1
ISSN	1534-6307 ; 1523-3774
ISSN (online)	1534-6307
ISSN	1523-3774
DOI	10.1007/s11926-018-0789-2
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Zs.A 5531: Show issues

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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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Article: Vascular endothelium as a target of immune response in renal transplant rejection.

Piotti, Giovanni / Palmisano, Alessandra / Maggiore, Umberto / Buzio, Carlo

Frontiers in immunology

2014 Volume 5, Page(s) 505

Abstract: This review of clinical and experimental studies aims at analyzing the interplay between graft endothelium and host immune system in renal transplantation, and how it affects the survival of the graft. Graft endothelium is indeed the first barrier ... ...

Abstract	This review of clinical and experimental studies aims at analyzing the interplay between graft endothelium and host immune system in renal transplantation, and how it affects the survival of the graft. Graft endothelium is indeed the first barrier between self and non-self that is encountered by host lymphocytes upon reperfusion of vascularized solid transplants. Endothelial cells (EC) express all the major sets of antigens (Ag) that elicit host immune response, and therefore represent a preferential target in organ rejection. Some of the Ag expressed by EC are target of the antibody-mediated response, such as the AB0 blood group system, the human leukocyte antigens (HLA), and MHC class I related chain A antigens (MICA) systems, and the endothelial cell-restricted Ag; for each of these systems, the mechanisms of interaction and damage of both preformed and de novo donor-specific antibodies are reviewed along with their impact on renal graft survival. Moreover, the rejection process can force injured EC to expose cryptic self-Ag, toward which an autoimmune response mounts, overlapping to the allo-immune response in the damaging of the graft. Not only are EC a passive target of the host immune response but also an active player in lymphocyte activation; therefore, their interaction with allogenic T-cells is analyzed on the basis of experimental in vitro and in vivo studies, according to the patterns of expression of the HLA class I and II and the co-stimulatory molecules specific for cytotoxic and helper T-cells. Finally, as the response that follows transplantation has proven to be not necessarily destructive, the factors that foster graft endothelium functioning in spite of rejection, and how they could be therapeutically harnessed to promote long-term graft acceptance, are described: accommodation that is resistance of EC to donor-specific antibodies, and endothelial cell ability to induce Foxp3+ regulatory T-cells, that are crucial mediators of tolerance.
Language	English
Publishing date	2014
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2606827-8
ISSN	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2014.00505
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Article ; Online: Anti-HLA and anti-SARS-CoV-2 antibodies in kidney transplant recipients with COVID-19.

Gandolfini, Ilaria / Zanelli, Paola / Palmisano, Alessandra / Salvetti, Daniel / Parmigiani, Alice / Maltzman, Jonathan S / Labate, Claudia / Fiaccadori, Enrico / Cravedi, Paolo / Maggiore, Umberto

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

2021 Volume 34, Issue 3, Page(s) 596–599

MeSH term(s)	Adult ; Aged ; COVID-19/immunology ; Female ; Follow-Up Studies ; HLA Antigens/immunology ; Humans ; Kidney Transplantation ; Male ; Middle Aged ; Postoperative Complications/immunology ; SARS-CoV-2/immunology ; Transplantation Immunology
Chemical Substances	HLA Antigens
Language	English
Publishing date	2021-02-26
Publishing country	England
Document type	Letter
ZDB-ID	639435-8
ISSN	1432-2277 ; 0934-0874
ISSN (online)	1432-2277
ISSN	0934-0874
DOI	10.1111/tri.13829
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