Impact of Everolimus and Low-Dose Cyclosporin on Cytomegalovirus Replication and Disease in Pediatric Renal Transplantation.

In order to investigate the hypothesis that the mammalian target of rapamycin inhibitor everolimus (EVR) shows anticytomegalovirus (CMV) activity in pediatric patients, we analyzed the impact of EVR-based immunosuppressive therapy on CMV replication and disease in a large cohort (n = 301) of pediatric kidney allograft recipients. The EVR cohort (n = 59), who also received low-dose cyclosporin, was compared with a control cohort (n = 242), who was administered standard-dose cyclosporin or tacrolimus and an antimetabolite, mostly mycophenolate mofetil (91.7%). Multivariate analysis revealed an 83% lower risk of CMV replication in the EVR cohort than in the control cohort (p = 0.005). In CMV high-risk (donor+/recipient-) patients (n = 88), the EVR-based regimen was associated with a significantly lower rate of CMV disease (0% vs. 14.3%, p = 0.046) than the standard regimen. In patients who had received chemoprophylaxis with (val-)ganciclovir (n = 63), the CMV-free survival rates at 1 year and 3 years posttransplant (100%) were significantly (p = 0.015) higher in the EVR cohort (n = 15) than in the control cohort (n = 48; 1 year, 75.0%; 3 years, 63.3%). Our data suggest that in pediatric patients at high risk of CMV, an EVR-based immunosuppressive regimen is associated with a lower risk of CMV disease than a standard-dose calcineurin inhibitor-based regimen.

The CERTAIN Registry: a novel, web-based registry and research platform for pediatric renal transplantation in Europe.

BACKGROUND: The results of pediatric renal transplantation have improved markedly in the last decade. However, a number of relevant clinical problems remain, such as organ damage caused by chronic rejection, long-term toxicity of immunosuppressive therapy, difficulty in developing tolerance-inducing protocols, secondary cardiovascular comorbidity, post-transplantation lymphoproliferative disease, suboptimal longitudinal growth, quality of life, adherence to immunosuppressive medication, and structured transition programs to adult care. These unmet clinical needs require intense collaborative and interdisciplinary clinical research. We recently founded the Cooperative European Paediatric Renal TransplAnt INitiative (CERTAIN; www.certain-registry.eu) as a research network and platform built on a novel, web-based registry. RESULTS: The registry's dataset provides essential information on generic kidney transplantation-related topics and also captures pediatric-specific topics, such as growth, physical and psychosocial development, and adherence. Due to its flexibility the system can be used as follows: (1) as a registry capturing a minimal or an extended dataset; (2) as a center and/or country-specific transplantation database; or (3) as a patient-specific electronic transplantation chart. The data can be exported directly from the CERTAIN web application into statistical software packages for scientific analyses. The rights regarding data ownership, evaluation, and publications are regulated in the registry's rules of procedure. Data quality is ensured by automatic software validation and a manual data review process. To avoid redundant data entry, CERTAIN has established interfaces for data change with Eurotransplant, the Collaborative Transplant Study (CTS), and the registry of the European Society of Pediatric Nephrology (ESPN) and European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) (ESPN/ERA-EDTA registry). CERTAIN fulfils all regulatory and ethical requirements of the European Union and Germany, in particular, regarding patients' data privacy and security. CONCLUSION: Using modern information technology, the recently established multinational CERTAIN Registry fills a gap in Europe for collaborative 5 research and quality assurance in the field of pediatric renal transplantation.

Linearity and reversibility of iodide adsorption on sediments from Hanford, Washington under water saturated conditions.

A series of adsorption and desorption experiments were completed to determine the linearity and reversibility of iodide adsorption onto sediment at the Hanford Site in southeastern Washington. Adsorption experiments conducted with Hanford formation sediment and groundwater spiked with dissolved (125)I (as an analog tracer for (129)I) indicated that iodide adsorption was very low (0.2 mL/g) at pH 7.5 and could be represented by a linear isotherm up to a total concentration of 100 mg/L dissolved iodide. The results of desorption experiments revealed that up to 60% of adsorbed iodide was readily desorbed after 14 days by iodide-free groundwater. Because iodide adsorption was considered to be partially reversible, even though small amount of initial iodide is retarded by adsorption at mineral-water interfaces, the weak adsorption affinity results in release of iodide when iodide-free pore waters and uncontaminated groundwaters contact the contaminated sediments in the vadose zone and aquifer systems.

Technetium reduction in sediments of a shallow aquifer exhibiting dissimilatory iron reduction potential.

Pertechnetate ion [Tc(VII)O(4) (-)] reduction rate was determined in core samples from a shallow sandy aquifer located on the US Atlantic Coastal Plain. The aquifer is generally low in dissolved O(2) (<1 mg L(-1)) and composed of weakly indurated late Pleistocene sediments differing markedly in physicochemical properties. Thermodynamic calculations, X-ray absorption spectroscopy and statistical analyses were used to establish the dominant reduction mechanisms, constraints on Tc solubility, and the oxidation state, and speciation of sediment reduction products. The extent of Tc(VII) reduction differed markedly between sediments (ranging from 0% to 100% after 10 days of equilibration), with low solubility Tc(IV) hydrous oxide the major solid phase reduction product. The dominant electron donor in the sediments proved to be (0.5 M HCl extractable) Fe(II). Sediment Fe(II)/Tc(VII) concentrations >4.3 were generally sufficient for complete reduction of Tc(VII) added [1-2.5 micromol (dry wt. sediment) g(-1)]. At these Fe(II) concentrations, the Tc (VII) reduction rate exceeded that observed previously for Fe(II)-mediated reduction on isolated solids of geologic or biogenic origin, suggesting that sediment Fe(II) was either more reactive and/or that electron shuttles played a role in sediment Tc(VII) reduction processes. In buried peats, Fe(II) in excess did not result in complete removal of Tc from solution, perhaps because organic complexation of Tc(IV) limited formation of the Tc(IV) hydrous oxide. In some sands exhibiting Fe(II)/Tc(VII) concentrations <1.1, there was presumptive evidence for direct enzymatic reduction of Tc(VII). Addition of organic electron donors (acetate, lactate) resulted in microbial reduction of (up to 35%) Fe(III) and corresponding increases in extractable Fe(II) in sands that exhibited lowest initial Tc(VII) reduction and highest hydraulic conductivities, suggesting that accelerated microbial reduction of Fe(III) could offer a viable means of attenuating mobile Tc(VII) in this type of sediment system.

Effect of electron donor and solution chemistry on products of dissimilatory reduction of technetium by Shewanella putrefaciens.

To help provide a fundamental basis for use of microbial dissimilatory reduction processes in separating or immobilizing (99)Tc in waste or groundwaters, the effects of electron donor and the presence of the bicarbonate ion on the rate and extent of pertechnetate ion [Tc(VII)O(4)(-)] enzymatic reduction by the subsurface metal-reducing bacterium Shewanella putrefaciens CN32 were determined, and the forms of aqueous and solid-phase reduction products were evaluated through a combination of high-resolution transmission electron microscopy, X-ray absorption spectroscopy, and thermodynamic calculations. When H(2) served as the electron donor, dissolved Tc(VII) was rapidly reduced to amorphous Tc(IV) hydrous oxide, which was largely associated with the cell in unbuffered 0. 85% NaCl and with extracellular particulates (0.2 to 0.001 microm) in bicarbonate buffer. Cell-associated Tc was present principally in the periplasm and outside the outer membrane. The reduction rate was much lower when lactate was the electron donor, with extracellular Tc(IV) hydrous oxide the dominant solid-phase reduction product, but in bicarbonate systems much less Tc(IV) was associated directly with the cell and solid-phase Tc(IV) carbonate may have been present. In the presence of carbonate, soluble (<0.001 microm) electronegative, Tc(IV) carbonate complexes were also formed that exceeded Tc(VII)O(4)(-) in electrophoretic mobility. Thermodynamic calculations indicate that the dominant reduced Tc species identified in the experiments would be stable over a range of E(h) and pH conditions typical of natural waters. Thus, carbonate complexes may represent an important pathway for Tc transport in anaerobic subsurface environments, where it has generally been assumed that Tc mobility is controlled by low-solubility Tc(IV) hydrous oxide and adsorptive, aqueous Tc(IV) hydrolysis products.