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Start Over Author "Willicombe M" Journal american journal of transplantation
29 results on '"Willicombe M"'

28. Postanastomotic Transplant Renal Artery Stenosis: Association With De NovoClass II Donor-Specific Antibodies

Author

Willicombe, M., Sandhu, B., Brookes, P., Gedroyc, W., Hakim, N., Hamady, M., Hill, P., McLean, A.G., Moser, S., Papalois, V., Tait, P., Wilcock, M., and Taube, D.

Abstract

In this study, we analyze the outcomes of transplant renal artery stenosis (TRAS), determine the different anatomical positions of TRAS, and establish cardiovascular and immunological risk factors associated with its development. One hundred thirty-seven of 999 (13.7%) patients had TRAS diagnosed by angiography; 119/137 (86.9%) were treated with angioplasty, of which 113/137 (82.5%) were stented. Allograft survival in the TRAS+ intervention, TRAS+ nonintervention and TRAS− groups was 80.4%, 71.3% and 83.1%, respectively. There was no difference in allograft survival between the TRAS+ intervention and TRAS− groups, p = 0.12; there was a difference in allograft survival between the TRAS− and TRAS+ nonintervention groups, p < 0.001, and between the TRAS+ intervention and TRAS+ nonintervention groups, p = 0.037. TRAS developed at the anastomosis, within a bend/kink or distally. Anastomotic TRAS developed in living donor recipients; postanastomotic TRAS (TRAS-P) developed in diabetic and older patients who received grafts from deceased, older donors. Compared with the TRAS− group, patients with TRAS-P were more likely to have had rejection with arteritis, odds ratio (OR): 4.83 (1.47–15.87), p = 0.0095, and capillaritis, OR: 3.03 (1.10–8.36), p = 0.033. Patients with TRAS-P were more likely to have developed de novoclass II DSA compared with TRAS− patients hazard ratio: 4.41 (2.0–9.73), p < 0.001. TRAS is a heterogeneous condition with TRAS-P having both alloimmune and traditional cardiovascular risk factors.

Published
2014
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29. Microcirculation Inflammation Associates With Outcome in Renal Transplant Patients With De NovoDonor‐Specific Antibodies

Author

de Kort, H., Willicombe, M., Brookes, P., Dominy, K. M., Santos‐Nunez, E., Galliford, J. W., Chan, K., Taube, D., McLean, A. G., Cook, H. T., and Roufosse, C.

Abstract

In renal transplant patients with de novodonor‐specific antibodies (dnDSA) we studied the value of microcirculation inflammation (MI; defined by the addition of glomerulitis (g) and peritubular capillaritis (ptc) scores) to assess long‐term graft survival in a retrospective cohort study. Out of all transplant patients with standard immunological risk (n = 638), 79 (12.4%) developed dnDSA and 58/79 (73%) had an indication biopsy at or after dnDSA development. Based on the MI score on that indication biopsy patients were categorized, MI0 (n = 26), MI1 + 2 (n = 21) and MI ≥ 3 (n = 11). The MI groups did not differ significantly pretransplantation, whereas posttransplantation higher MI scores developed more anti‐HLA class I + II DSA (p = 0.011), showed more TCMR (p < 0.001) and showed a trend to C4d‐positive staining (p = 0.059). Four‐year graft survival estimates from time of indication biopsy were MI0 96.1%, MI1 + 2 76.1% and MI ≥ 3 17.1%; resulting in a 24‐fold increased risk of graft failure in the MI ≥ 3 compared to the MI0 group (p = 0.003; 95% CI [3.0–196.0]). When adjusted for C4d, MI ≥ 3 still had a 21‐fold increased risk of graft failure (p = 0.005; 95% CI [2.5–180.0]), while C4d positivity on indication biopsy lost significance. In renal transplant patients with de novoDSA, microcirculation inflammation, defined by g + ptc, associates with graft survival.

Published
2013
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