Publications by authors named "Umberto Maggiore"
Article Synopsis
- * Despite the known association with complement activation, evidence shows that microvascular inflammation and endothelial damage can occur independently of this system, particularly in late AMR (>6 months post-transplant).
- * The review discusses differences in mechanisms and clinical features between early and late AMR, suggesting that treatment strategies should reflect these variations in underlying inflammatory processes and complement activation levels.
Article Synopsis
- Antibody-mediated rejection (AMR) is a major cause of long-term kidney transplant failure, even with advancements in immunosuppressive therapies.
- * A case is described where late active AMR progressed to severe chronic active AMR, treated with a multidrug approach.
- * The current treatment options and understanding of AMR, including the role of donor-specific antibodies and various therapeutic strategies, highlight a need for improved guidelines based on stronger evidence.*
Background: Despite the burden of pyelonephritis after kidney transplantation, there is no consensus on initial empirical antibiotic management.
Methods: We surveyed clinicians throughout the world on their practice and opinions about the initial empirical therapy of post-transplant pyelonephritis, using clinical vignettes. A panel of experts from 19 countries on six continents designed this survey, and invited 2145 clinicians to participate.
Microvascular inflammation (MVI), defined as the presence of glomerulitis and/or peritubular capillaritis, is the key histological lesion of anti-HLA donor-specific antibodies (DSA)-related antibody mediated rejection, but recently other possible mechanisms of MVI have emerged. However, except for peritubular capillary C4d deposition that is more frequently observed in the presence of anti-HLA-DSA, histological features are similar regardless of MVI origin. Therefore, accurately describing patterns of MVI may help differentiate etiologies and drive therapeutic choices.
View Article and Find Full Text PDFBackground: Three different histological scores-histopathologic classification (Berden), Renal Risk Score (RRS) and the Mayo Clinic Chronicity Score (MCCS)-for anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (ANCA-GN) were compared to evaluate their association with patient and kidney prognosis of ANCA-GN.
Methods: Patients aged >18 years with at least 1 year of follow-up and biopsy-proven ANCA-GN entered this retrospective study. Renal biopsies were classified according to Berden's classification, RRS and MCCS.
IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. IgAN causes end-stage kidney disease (ESKD) in 30-40% of all cases. The activation of the complement system by pathological circulating IgAs, which is often associated with low serum C3 levels (LowC3), seems to play a crucial role.
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- The study examines the necessity of treatment with intravenous steroids versus clinical follow-up for kidney transplant recipients diagnosed with "borderline" acute T-cell mediated rejection (TCMR).
- Researchers followed 59 patients over 12 months, comparing the groups receiving treatment (TRT) and those with simple clinical follow-up (F-UP), measuring trends in renal function through estimated glomerular filtration rate (eGFR).
- Results showed that while the TRT group initially had lower kidney function, they reached comparable eGFR levels to the F-UP group after 12 months, indicating that treatment may be beneficial in cases with indication biopsies.
Introduction: Diagnosis and management of microscopic polyangiitis (MPA) have evolved considerably over the past decades, but it is unknown whether clinical and histological presentation and patient and renal outcomes have changed accordingly.
Methods: We compared clinical and histopathological characteristic at diagnosis, risk of death, end-stage kidney disease (ESKD), and relapse rate in patients diagnosed with MPA between 1980 and 2022, after grouping them in 2 periods (p): p1980-2001 and p2002-2022. We compared the mortality rate between the 2 periods using Kaplan-Meier estimator and Cox-regression, and competing risks of ESKD and death using the Aalen-Johansen estimator, Fine-Gray multiple regression, and multistate models.
Opting for a preemptive kidney transplant (PKT) can help avoid costs and morbidity associated with dialysis. However, while multiple studies have shown clinical benefits of PKT, other studies have not demonstrated this, leading to controversy in the literature regarding the exact benefits of PKT. Therefore, this study aimed to determine the clinical outcomes of PKT versus non-preemptive kidney transplantation (nPKT) in adult patients.
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- Kidney transplant (KT) recipients who receive transplants from HLA identical siblings (HLAid) have a lower immunological risk, but specific immunosuppression guidelines for them are lacking.
- A systematic review analyzed 16 relevant studies involving 5636 HLAid KT recipients, focusing on different immunosuppression strategies and their effectiveness.
- The findings revealed a poor quality of evidence regarding immunosuppression approaches, with most older studies and no strong conclusions linking immunosuppression to outcomes based on current immunological risk assessments.
Immigrants from outside Europe have increased over the past two decades, especially in Southern European countries including Italy. This influx coincided with an increased number of immigrants with end-stage organ diseases. In this narrative review, we reviewed evidence of the gaps between native-born and immigrant populations in the Organ Donation and Transplantation (ODT) process in Italy.
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- - The study investigated the impact of the modified Oxford classification of MEST-C components on graft failure in kidney transplant recipients with IgAN, focusing on a North American cohort to validate previous findings from an Asian population.
- - It analyzed 171 transplant recipients, discovering that recurrent IgAN significantly heightened the risk of graft failure, especially in younger patients, and that a higher MEST-C score was associated with increased failure risk.
- - The results showed consistency with the Asian cohort's findings, suggesting that the MEST-C score could serve as a valuable tool in diagnosing and managing recurrent IgAN in kidney transplant patients.