Inflammation and oxidation: do they improve after kidney transplantation? Relationship with mortality after transplantation

Summary

Patients with chronic kidney disease (CKD) are characterized by a state of inflammation and oxidative stress that seems to improve after kidney transplantation (KT). Nevertheless, there is controversy regarding what is the best marker that better define inflammation and specially oxidative stress.

Objective

To evaluate the biomarkers which are associated with improvements in inflammation and lipid peroxidation in patients who have undergone KT. To evaluate the relationship between inflammation, lipid peroxidation and mortality in KT.

Patients

196 KT (between 2003 and 2008). 67.9% men; median age: 51.9 years. Inflammation markers analyzed previous KT and 3 months after KT: c-reactive protein(CRP), interleukin 6(IL-6), tumor necrosis factor alpha(TNFα), soluble tumor necrosis factor receptor alpha(sTNFRα), soluble interleukin-2 receptor (sIL-2R). Lipid peroxidation markers analyzed: oxidized low-density lipoprotein (oxLDL) and anti-oxLDL antibodies. Calculation of glomerular filtration rate after KT: MDRD equation.

Results

Following KT, there is a significant decrease in CRP (p = 0.006), IL-6 (p = 0.0037), TNFα (p < 0.0001), sTNFRα (p < 0.0001) and sIL-2R (p < 0.0001), while levels of oxLDL increase after KT (p < 0.0001) and there is not a significantly difference in anti-oxLDL. 12.8% of the patients had died in 2012. These patients had higher levels of IL-6 (p = 0.011) and sTNFRα (p < 0.006) after KT and a lower MDRD (p < 0.0001), hemoglobin (p = 0.012) and albumin (p = 0.007). We observed no statistically differences in the levels of markers previous KT. Of the patients who died, the 43.5% of them had anti-oxLDL antibody levels greater than 75th percentile (P₇₅: 3781 UI/ml, p = 0.028). In the multivariate analysis, age (OR:1.12; p = 0.0129), MDRD (OR:0.92; p = 0.013) and P₇₅ of anti-oxLDL(OR: 5.19; p = 0.026) were independent risk factors for mortality. Independent risk factors for survival were: P₇₅ of IL-6 (HR: 2.45; p = 0.027), oxLDL (HR:19.85; p = 0.002) and anti-oxLDL (HR: 9.55; p = 0.003).

Conclusions

KT improved inflammation but not lipid oxidative state. KT patients who died had a higher inflammatory state (with higher levels of IL-6 and sTNFRα), a worse lipid oxidative state and a worse renal function 3 months after KT. Age, anti-oxLDL and renal function at 3 months after KT were independent risk factors for mortality.

     

Evaluation of the effect of probiotics in the treatment of peri-implant mucositis: a triple-blind randomized clinical trial

Objectives

To determine if the treatment of mucositis with mechanical debridement, 0.12% chlorhexidine, and a further application of Lactobacillus reuteri (L. reuteri) will result in an improvement of the clinical and microbiological parameters in comparison to the treatment with mechanical debridement and 0.12% chlorhexidine alone.

Material and methods

Fifty dental implants with mucositis in 50 patients were randomly assigned to one of the following groups: mechanical debridement, 0.12% chlorhexidine mouthwash, and the subsequent administration of a probiotic agent (test group) or mechanical debridement and 0.12% chlorhexidine mouthwash (control group). Data were analyzed to determine clinical and microbiological changes during treatment and after a follow-up period of 3 months.

Results

After the administration of 0.12% chlorhexidine, all clinical parameters improved in the test and the control group, observing a significant decrease in Full Mouth Plaque Index (FMPI), full mouth bleeding on probing (FMBOP), Plaque Index (PI), and bleeding on probing (BOP) at the implant. However, following the administration of probiotics or placebo, the clinical variables, except for probing pocket depth, slightly and progressively increased up to 3 months of follow-up, but without reaching baseline levels. From a microbiological point of view, no major alterations of the subgingival microflora were recorded at different time points between groups during the study.

Conclusions

Treatment with mechanical debridement, oral hygiene reinforcement, and administration of 0.12% chlorhexidine was effective in reducing mucositis, but it did not always result in complete resolution of inflammation. The administration of probiotics did not seem to provide an additional clinical or microbiological benefit.

Clinical relevance

The use of probiotics does not seem to provide an additional benefit in the treatment of peri-implant mucositis.

     

Follow up of the Humoral Response in Healthcare Workers after the Administration of Two Dose of the Anti SARS-CoV-2 Vaccines—Effectiveness in Delta Variant Breakthrough Infections

The implementation of vaccination among healthcare workers (HCWs) allowed the management of the pandemic in a manner that differed from that in the first waves. It has been demonstrated that the mRNA vaccines elicit good humoral responses but that there are still breakthrough infections. In summer 2021, a fifth wave emerged, despite the good coverage of HCWs in Spain. We aimed to study the SARS-CoV-2 IgG antibody levels as a marker to predict the possibility of Delta variant infections after vaccination after a seroepidemiological campaign. Of the 5000 participants, a total of 4902 (98.04%) showed a positive result in the serological anti-S test and only 98 (1.96%) were negative. Among the 4368 fully vaccinated participants, only in five cases was the serology negative. Of the total number of participants that received antibody results during the study, 162 were PCR positive in the subsequent two months. Among these, 151 were fully vaccinated (two doses). Significant differences between antibody BAU/mL levels were found between PCR positive and non-PCR positive participants (p < 0.01). The median of BAU/mL was higher in those vaccinated patients with no infection (1260 BAU/mL; 465–2080) versus infected patients (661 BAU/mL; 361–2080). These data support the idea that vaccines play an important role in the control of the pandemic, especially among HCWs at the time of the Delta variant circulation. More studies with other variants of concern must be performed in order to establish a correlation between the levels of IgG and the new infections.