Morphological features and molecular phylogeny of <Emphasis Type="Italic">Hoferellus azevedoi</Emphasis> n. sp. (Myxozoa: Myxobilatidae) found in <Emphasis Type="Italic">Chaetobranchus flavescens</Emphasis> Heckel, 1840 (Teleostei: Cichlidae) from Marajó Island,northern Brazil

Hoferellus azevedoi n. sp. was found in the urinary bladder of Chaetobranchus flavescens Heckel, 1840 from the Arari River on Marajó Island in Pará, Brazil. This is the first record of a species of the genus Hoferellus in a host from the Brazilian Amazon region. The new species has disporous and polysporous plasmodia, which vary in size and shape, with some being found adhered to the epithelium of the urinary bladder, and others floating in the liquid. The mature spores are sub-spherical in the sutural view, with a number of peripheral projections around the whole surface of the spore. In the sutural view, the spores are 5.3 ± 0.2 (5.2–5.6) μm in length and 7.0 ± 0.7 (6.3–7.7) μm in width, with two piriform polar capsules of equal size, 2.5 ± 0.2 (2.3–2.8) μm long and 1.8 ± 0.2 (1.6–2.0) μm wide. Based on a partial (1312 bps) sequence of the SSU rDNA gene, Hoferellus azevedoi n. sp. was distinguished from all the other myxozoan species deposited in GenBank. Phylogenetically, based on Bayesian inference and p-distances, the new species was allocated to the “Freshwater Urinary-Bladder” clade, together with other myxozoan parasites of the excretory system. Based on the morphological data, supported by the partial sequence of the SSU rDNA gene, we describe a new species of myxozoan, Hoferellus azevedoi n. sp.     

Outcomes Associated with Steroid Avoidance and Alemtuzumab among Kidney Transplant Recipients

Background and objectives

Alemtuzumab is a humanized anti-CD52 monoclonal antibody used as induction in kidney transplantation (KTX) since 2003. Few studies have evaluated long-term outcomes of this agent or changes in outcomes over time.

Design, setting, participants, & measurements

A retrospective cohort study was performed examining United States registry data from 2003 to 2014 of primary KTX recipients receiving induction with alemtuzumab (AZ; n=5521) or antithymocyte globulin (ATG; n=8504) and maintenance immunosuppression with tacrolimus and mycophenolate mofetil and early withdrawal of steroids. The primary outcome was overall death-censored graft survival (DCGS), and secondary outcomes were overall patient survival and 1-year acute rejection. Multivariate models were fit with donor, recipient, and transplant covariates. Because poorer outcomes with AZ may occur from a learning curve impact with the use of a new medication, transplant year was categorized into three time periods to evaluate outcomes over time (2003–2005, 2006–2008, ≥2009), and an interaction term of induction type with transplant year category was included in all models to test for era impacts.

Results

On multivariate analysis of DCGS there was a significant interaction between AZ and era (P<0.001). AZ was significantly associated with inferior DCGS in the earliest 2003–2005 era (adjusted hazard ratio [aHR], 2.21; 95% confidence interval [95% CI], 1.72 to 2.84) but not in the middle 2006–2008 era (aHR, 1.14; 95% CI, 0.96 to 1.36) or the most recent 2009–2014 era (aHR, 1.08; 95% CI, 0.90 to 1.29) compared with ATG. Risk-adjusted patient survival (aHR, 1.32; 95% CI, 1.08 to 1.61; aHR, 1.26; 95% CI, 1.09 to 1.46; and aHR, 1.10; 95% CI, 0.93 to 1.29 by era, respectively) and acute rejection (adjusted odds ratio [aOR], 1.17; 95% CI, 0.96 to 1.42; aOR, 0.94; 95% CI, 0.82 to 1.07; aOR, 0.89; 95% CI, 0.81 to 0.98 by era, respectively) with AZ was comparable with ATG in the most recent era; however, there was no significant interaction with time (P=0.13 and P=0.06, respectively).

Conclusions

Current alemtuzumab utilization is associated with comparable graft and patient survival and acute rejection compared with ATG. Graft survival with alemtuzumab has improved over time.