Leonardo V. Riella
@LVRiella
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Medical Director of Kidney Transplantation @MGHKidneys @HarvardMed . Clinician, scientist & educator. Tweets are my own
Boston, MA
Joined June 2015
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Pinned Tweet
With tremendous joy, I share that our patient who received a gene-edited pig kidney transplant was discharged home today after removal of his dialysis access. We hope that this is a first step that will bring hope to many patients waiting for a kidney transplant
#xenotransplant
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1/8 Xenotransplantation is a reality! A major breakthrough was reported as the first heart from a pig(xeno) was transplanted into a human in Baltimore. Although press releases don't provide all relevant details,we will attempt to answer a few of the specific important points here
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Is there difference in tacrolimus absorption comparing morning dose vs. evening dose? If using split doses (2mg/3mg), should you do the higher dose in the morning or at night? Our amazing pharmacist
@pharmadkayla
teaching us about circadian variation in absorption. Higher dose:pm
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Learn more about our kidney
#xenotransplant
@mgh_transplant
This short video provides an overview of the rationale, the details about the immunosuppression used, and the precautions taken in our study. Click on the second video in the video section @
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1\First
#kidney
#xenotransplant
report finally published
@amjtransplant
with details about the procedure & outcomes.
@uabmedicine
, a 350 pound mutated pig had both kidneys transplanted into a brain-dead donor whose native kidneys had been removed. 👇
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To our amazing
@BWHKidney
@MGHKidneys
renal fellows, thanks for your hard work, passion & dedication. It has been a pleasure to be part of your training and looking forward to continuing to learn from you. Honored in receiving the 2020 BWH Renal Physician of the Year Award!!
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As part of TANGO collaboration to study glom disease recurrence post-tx across 18 centers worldwide (), excited to share that our FSGS recurrence paper has been selected as one of the top 5
@CJASN
articles of 2020! 👊 Audrey Uffing&our amazing collaborators
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I'm deeply grateful to the
@nephcure
Foundation for awarding me the 2023 NephCure Medical Award.This foundation truly puts patients first, offering vital support to kidney patients and pushing forward with important research goals.Thank you for this incredible honor!
@MGHKidneys
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SGLT2 inhibitors have revolutionized kidney disease with improvements in cardiovascular and kidney disease progression.The puzzle is that the glucose effect seems out of proportion to the benefits that we see in the clinic. Cool paper shows off-target effect of SGLT2i in T cells!
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One step closer to
#xenotransplantation
. On a smart approach, a mutated pig kidney was implanted into a brain-dead patient & the kidney functioned for 54 hours. Hopefully, very soon, we will be seeing a clinical trial w/pts on dialysis on the awaiting list
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#Salt
intake associated with accelerated disease progression in
#polycystic
kidney disease and this was independent of blood pressure. The deleterious effect of salt keeps expanding
@Kidney_Int
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We have enough evidence now NOT to treat with antibiotics asymptomatic bacteriuria in kidney recipients >2 months post-transplant. Use of antibiotics did not affect the incidence of symptomatic UTI but increased antibiotic-resistant bugs.
@KottonNelson
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Proud of this
@CJASN
review article on
#Glomerular
disease
#Recurrence
post-tx in collaboration w/ Jonathan Hogan,Audrey Uffing &Frank Hullekes
@MGHKidneys
@mgh_transplant
Unique article format, focusing on challenges in FSGS, MN, C3GN, IgA, AL amyloidosis &aHUS recurrence posttx
3
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Donor-recipient HLA matching correlates with long-term transplant survival. Historically, donor-recipient pairs mismatch has focused on three major HLA loci: A, B and DR (most polymorphic). Recent paper
@JASN_News
indicates more attention to DQ mismatches, esp in minorities
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Efficacy of 3 doses of Pfizer vaccine in 101 transplant recipients (78 kidney) in France
@NEJM
Antibody response against SARS-Cov2 was 40% after second dose and 68% after third dose. 44% of patients neg after 2 doses had a +Ab response after the third dose. No safety concerns.
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Join us this Friday July 10th at 12:30pm for our
@MGHKidneys
@MGHMedicine
Summer Transplant Teaching Series - Transplant Immunology 101 for students, fellows &trainees. “Immunobiology in Transplantation”
@RenalFellowNtwk
@amjtransplant
@ESOTtransplant
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Does vitamin D deficiency really exist? Dr.Thadani makes the argument that difference in levels are primarily determined by genetic factors and cut offs currently used are not adjusted for that.Vit D is a 2 billion dollar industry and each lab test for vit D costs 150 dollars!
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Since first kidney transplant >50 years ago, little has changed in the approach to prevent rejection after transplant. Excited to share our work changing the paradigm by expanding Tregs& allowing immunosuppression reduction View details 👇
@mgh_transplant
🚨Our JCI paper is out!🚨
👉Teamwork in designing and showing efficacy of novel mutein IL-2 in transplant models and setting the stage for clinical testing.
👉Many thx to my great mentor
@LVRiella
@ThiagoJBorges
@Visterra_Inc
& team!
👉
🧵Our findings👇1/11
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Just out!
#COVID19
#kidney
#transplantation
. Amazing collaborative work among 9,845 patients across 12 transplant centers in US&Europe. Goal: better understand outcomes of COVID19 in hospitalized kidney transplant pts. Honored to be part of this group!
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Hot off the press! Excited about our work out
@NatureComms
1) We identified a crucial role of donor CD103+ DCs in triggering rejection; 2) We developed a potential novel complementary treatment strategy to treat donor organ prior to tx & reduce rejection
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Genetic susceptibility to IgA nephropathy, membranous nephropathy and steroid-sensitive nephrotic syndrome.
@kirylukk
Clearly indicative of crucial aspect of immune system in driving disease pathogenesis->how specific HLA class II alleles & immune genes assoc w/ specific diseases
2
28
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A great case presented
@MGHKidneys
@MGHPathology
by visiting nephrologist Piotr Donizy from Poland. 40 yo with ESRD of unclear etiology (history of renal colics) who has rising creatinine 2 months after kidney transplant. Biopsy below. What is the diagnosis?
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Excited to share this collaborative multicenter effort led by
@nymurakami
@kdjhaveri
looking at the safety and efficacy of immune checkpoint inhibitors in kidney transplant recipients.
@mgh_transplant
@MGHKidneys
@BWHKidney
3
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I was hoping to see a study like this to answer the following question: Does interruption of mycophenolate improve antibody response after SARS-Cov2
#vaccination
in
#transplanted
patients? Randomized trial suggests that it does not!
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Amazing effort in the transplant centers worldwide screened 11,742 patients&collected clinical data on
#FSGS
#recurrence
after
#kidney
#transplant
.Thanks all members of TANGO for making this possible!👏
@BWHKidney
@harvardmed
@IcahnMountSinai
@cravedilab
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After a challenging year
#COVID19
, we were finally able to get the amazing MGH Kidney Transplant Team together for an outdoor event
@mgh_transplant
@MGHKidneys
. Grateful for what we have achieved this past year and to be working with such a stellar team! The sky's the limit
1
7
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Nice review on idiopathic nephrotic syndrome in children
@TheLancet
Illustration of pathogenesis of NS, treatment strategies and recommendations from different societies/guidelines.
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New potential treatment for APOL1-related FSGS
@NEJM
. Inaxaplin, an oral inhibitor of APOL1-mediated pore formation in podocytes. Treatment reduced urine protein/Cr ratio by 47% in 13 pts w/ APOL1 mutations, proteinuric CKD, & FSGS at 13 weeks. Validation in larger trial next.
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Incredible case of refractory lupus treated with chimeric antigen receptor (CAR)–modified T cells (genetically engineered to recognize CD19 & destroy those cells). Significant response&no major adverse events.
@NEJM
We are working on a trial for sensitized patients.More to follow
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Excellent 1stweek in transplant rotation with superstar fellows Rob Hayden (1st y)
@AlJurdi
(tx fellow). Tons of learning: pyelo, diarrhea Rx, kidney stone, combined liver/kidney transplant, islet cell tx, MPGN post-tx, lung tx AKI, thymo side effects, heart failure…
@MGHKidneys
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4
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Small cohort of 20 older patients (mean age of 60) with kidney
#transplant
that had developed COVID19. 6 patients developed AKI. Despite few experimental treatments against SARS-CoV2 (including HQ) , about 25% mortality. More data needed
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False AKI:
#Ketogenic
diet&
#Creatinine
. Gentleman referred to nephrology due to creatinine elevation to 1.5mg/dL (baseline 1 mg/dL). No new meds. Urinalysis clear. Well controlled hypertension.He had started a ketogenic diet week before. Cystatin C ordered -> 0.78->normal eGFR.
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Our Division
@BWHKidney
getting ready for
@ASNKidney
#kidneyweek
💪 Strong presence with 94 accepted research abstracts! Hope to catch up with many of you next week!
#kidneydisease
#transplantation
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Rituximab given as part of the induction regimen (in ABO incompatibles)was associated with⬇️risk for PTLD in a large Swiss nationwide cohort with 4,765 transplanted patients. Learn more by joining
@AST_info
@amjtransplant
journal club on March 9th
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We are excited and honored to have
@AlexandreLoupy
visiting
@mgh_transplant
@MGHKidneys
and presenting next week on Prediction Systems in Transplant Medicine. Looking forward to fruitful interactions and exchanges!
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Check our review on IgA nephropathy. Really nice overview of the multiple immune mechanisms involved... Kudos to Micaela Gentile, Luis, Alberto,
@jmanriquees
Simona, Enrico, Francesco, Gianluigi,
@cravedilab
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We need less nephrotoxic immunosuppressive drugs... Reviewing 10y allograft biopsy paper from Stegall et al
@amjtransplant
showing ⬆️rate of chronic changes (from 5% at time of tx to 82% at 10y), such as arteriolar hyalinosis, mesangial sclerosis and global glomerulosclerosis.
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Increased rate of Zoster infection in transplanted patients. Nice review today from Cesar Berto
@mgh_transplant
Really important to get vaccinated with Shingrix vaccine as immunity reduces with age and immunosuppression increase significantly the risk of Zoster. Rash and pain.
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Great lecture on Prediction Systems in Transplant Medicine
@AlexandreLoupy
while visiting
@mgh_transplant
@MGHKidneys
. Few shots from Ether Dome where the first demonstration of anesthesia was performed in 1846
@MGHMedicine
@MGHSurgery
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Excited to share our vaccine study in kidney
#transplantation
@mgh_transplant
@MGHKidneys
@BWHKidney
@jazziup
@KottonNelson
-
@AlJurdi
describes in this video the mechanism of action
#COVID19
mRNA vaccines & their potential benefits in transplanted patients
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Path 1/3
@BWHKidney
Rennke presents a beautiful image of atheroembolic kidney disease after cardiac catheterization. Usual path sample processing removes cholesterol from the block. But nice toluidine blue staining protocol in plastic section for electron microscopy 👍
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Case of recurrent of glomerular disease post-transplant
@AlJurdi
@mgh_transplant
@MGHKidneys
Learning points:*Important to dive into the kidney disease progression history during tx evaluation (any red flags? Too quick progression?);*Obtain prior native kidney biopsy
#TANGOstudy
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On May 14th, we will have a special guest Dr. Joel Topf
@kidney_boy
as visiting professor at the BWH/MGH Renal Grand Rounds
@BWHKidney
@MGHKidneys
. Looking forward to your visit Joel!
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Amazing collaborative effort on TANGO consortium to investigate IgA nephropathy recurrence post-tx. Proud to be part of this international team tackling recurrence of glomerular disease. 23% recurrence at 15 years with median time of recurrence 3.4y
@CJASN
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A randomized controlled trial assessing single dose Fosfomycin at time of stent or urinary cath removal(n=82)-> lower rates of UTI post-kidney transplantation on fosfomycin arm (7.3% vs 36%).All patients were receiving trimethoprim/sulfamethoxazole prophylaxis.
@NDTsocial
3
20
63
What happens with pts with
#FSGS
recurrence post-transplant that require months-years of plasmapheresis for remission? New study from our TANGO group reported on the largest series so far.
@mgh_transplant
@MGHKidneys
@cravedilab
Uffing, Berger
@KIReports
5
24
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In patients with C3 glomerulopathy, do serum levels of C3 and soluble C5b-9 help with risk stratification? A study from Chauvet et al.
@Kidney_Int
suggests it may help identify patients with worse outcomes.
2
24
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A pleasure to have
@Nephro_Sparks
@MGHKidneys
Grand rounds sharing all his knowledge on the Renin-Angiotensin System, including some historical perspectives: 1) First Captopril clinical paper
@NEJM
with 12 hypertensive patients, 2) Enalapril reducing mortality in CHF. 3) RENAAL
1
11
61
A great review from Ira
@MGHKidneys
@MGHPathology
about collagen chain assessments in kidney biopsy and how they can be used to identify specific forms of Alport Syndrome.
0
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Population-based study comparing survival of dialysis patients to patients with most common cancers. Nice perspective of the significant impact of kidney disease on patient survival and the lack of change over time!
@AJKDonline
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Strong
@BWHKidney
Renal Division representation among the awardees of the
@BrighamWomens
@BrighamResearch
Department of Medicine Annual Reasearch Award. Congrats to
@nymurakami
and
@DavidLeaf9
!
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5
57
Tacrolimus is associated w/vasoconstriction and ↓eGFR. Do transplant recipients who have vascular disease on kidney bx experience ↑benefit after conversion to
#belatacept
?
@CKJsocial
study from my group
@mjoperezsaez
showed indeed a benefit
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29
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Do We Need CAR T-Cells to Effectively Desensitize High PRA Patients?
#ATC2022
We are excited to be part of this study looking at the use of CAR T cells for desensitization in kidney transplant candidates, targeting CD19&BCMA.
@mgh_transplant
@MGHSurgery
@NYUnephro
@PennKidney
4
9
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Focal Segmental Glomerulosclerosis Recurrence Posttransplant: It Takes Two to TANGO. Strong work from Frank and Ruchama on this piece about
#FSGS
recurrence
#post
-transplant
@KidneyNews
@ASNKidney
0
21
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Amazing renal grand rounds
@rheault_m
re:Alport's syndrome. Interesting learning points: Autosomal dominant = 19-31% of cases expansion over time likely related⬆️genetic testing-family hx not essential, females w/ AS less likely to have anti-GBM dz post-tx & mechan of glom injury
1
14
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Excited to share our latest work in transplantation tolerance, which combines costimulation blockade with upregulation of PD1 inhibitory signaling to promote tolerance
@JCI_insight
Kudos to our strong team led by Thiago Borges
1
14
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Important work showing the antibody response against SARS-Cov2 in kidney transplant recipients.
@cravedilab
@ISMMSKidney
@mgh_transplant
@MGHKidneys
3
30
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Help us improve the future of
#kidney
#transplant
patients! Our lab is one of 3 finalists of
#BRIghtFuturesPrize
.The prize would support the development of home-based urine test to monitor
#rejection
before it occurs. Help us by voting &forwarding the link
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Renal Division Annual Picture
@MGHKidneys
in the Ether Dome! What a team of talented, dedicated and smart physicians. Honored to be part of this Stellar Team!
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Excellent case
#AKI
in multiple myeloma due to kappa light chain cast nephropathy.‼️Initial kappa LC was not elevated due to prozone effect. Dilution of serum led to a level above 60K. Important learning point in cases with discrepancies. By Nora Alzahrani
@MGHKidneys
@BWHKidney
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Hot off the press
@natBME
our new point-of-care urine test using
#CRISPR
to diagnose rejection and opportunistic infections in
#kidney
#transplant
patients.Adapted results✅ pregnancy pen.Collaborative effort
@BWHKidney
@BrighamResearch
@MIT
@KaminskiLab
2
16
52
Recommended vaccination chart for transplanted patients and dialysis patients as well as other scenarios. One dose of PCV13 followed by 1 dose of PPSV23 at least 8w after;2nd dose of PPSV23 at least 5 years after the first dose of PPSV23.Helpful link here:
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Excited to see new treatments emerging for C3 glomerulonephritis. On this phase II study, iptacopan, a proximal complement inhibitor that binds to factor B was capable of reducing proteinuria and C3 deposits in kidney transplanted patients (n=11)with recurrent C3GN.
@KIREports
2
15
51
Great lecture 1/3
@KottonNelson
about vaccination of solid organ transplant recipients. Novel
@CDCgov
guidelines 2021 just out!
2
23
51
IgA recurrence postransplant. Dr Bhalla showing that multiple studies with current immunosuppression regimens (tacrolimus/mmf) have debulked the notion that steroids prevent IgA recurrence.
#ATC2023SanDiego
2
17
50
Amazing first 2wks
@MGHKidneys
@mghtransplantmd
14 new kidney
#transplants
in July, we launched the Transplant Immunology 101 series w/ Sandro and Thiago, joined the virtual biopsy rounds with Bob Colvin & getting our lab ready for full operation🔬. Thanks for the warm reception!
1
2
51
New Omicron
#COVID
data on kidney
#transplant
recipients
@mgh_transplant
@BWHKidney
Third dose of mRNA vaccines increases antibody responses against WT and delta variant of SARS-CoV-2, while neutralizing responses to the Omicron variant remain markedly reduced. Important work!!!
Excited to share our work on antiviral humoral responses to the Omicron variant after the 3rd mRNA vaccine dose in kidney transplant recipients (preprint on
@medrxivpreprint
)
@LVRiella
7
22
105
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20
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Excited to be heading to New Orleans
@ASNKidney
#Kidneywk
-Opening tomorrow pre-meeting w/ immunobiology in transplantation room 294
5
13
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Case report
@mgh_transplant
@MGHKidneys
: Successful simultaneous heart-kidney transplantation across a positive complement-dependent cytotoxic crossmatch using a multi-target approach.
0
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Nice guidelines synopsis for the primary prevention of
#cardiovascular
disease
@JAMA_current
Adults aged 40-75yo being evaluated for CVD prevention should have a 10-year ASCVD risk estimation before starting pharmacological therapy(antihypert,statin, ASA)
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Regulatory T cells are critical inhibitors of the immune response. Check this trial from our team
@mgh_transplant
In a pilot study, expanding donor-specific Tregs in vitro & then infusing in tx patients was safe & allowed immunosuppression reduction after transplantation.
2
19
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Our paper is out
@CircAHA
after >5y of work. We have identified
#Notch
-1 as a promising target to promote immune regulation & induce tolerance in
#transplantation
. Translational approach with animal&human exp Special congrats C.Magee,
@nymurakami
, T. Borges
4
12
47
We are excited to see our review out, which includes a transplant section about all reported work on immune
#checkpointinhibitors
' use in kidney
#transplantation
. Overall incidence of
#rejection
is ~50% with
#anti
-PD1 and about 35% with
#anti
-CTLA4.
Immune checkpoint inhibitor nephrotoxicity: Update 2020 by
@ShrutiGkidney
Frank Cortazar
@LVRiella
and David E. Leaf
@BrighamWomens
0
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13
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We are excited to launch the first Transplant Center for Tolerance in the world! >30y science &expertise
@mgh_transplant
@harvardmed
Patients who receive a kidney transplant will have the opportunity to live without immunosuppressive drugs. Options for new& previous tx patients
Learn more about the Legorreta Center for Clinical Transplant Tolerance at Mass General
0
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2
6
48
Just launched 4th ed Kidney Transplant eBook!Over 50 new pics,questions&updated literature. Thx for all the support!
6
22
47
Great case from Rennke
@BWHKidney
showing the importance of electron microscopy in kidney biopsies.Subnephrotic range proteinuria and ^ creatinine. Biopsy showed mild mesangial expansion. IF neg. EM w/ immunotactoid deposits.Paraffin IF with IgG2/lambda + stain
#renalpath
2
16
47
Editorial Board meeting
@amjtransplant
showing the rising impact factor >8 and some of the top tweets of AJT articles this past year
1
4
47
0
1
45
Really proud of our my research team this month! 4 publications out & 2 awards! Although those are important, in the end, it is all about the journey. Enjoying, learning and having fun with our enthusiastic young trainees and collaborators! I could not ask for more...
3
4
45
Path 2/3
@BWHKidney
Rennke shows osmotic tubulopathy after IVIG on EM. Characterized by cytoplasmic vacuolation. Sucrose (carrier for IVIg) undergo pinocytosis and enter the cell where they are translocated into lysosomes, leading to accumulation and eventual tubular cell injury
1
13
44
Our team getting ready for
#ATC2020Virtual
@AST_info
Intense editing of images & slides for the recorded presentations on PowerPoint. Looking forward to learning and sharing virtually with others the advancements in
#Transplant
.
@BrighamResearch
@BWHKidney
@MGH_RI
@MGHKidneys
1
5
44
Great session on the spectrum of antibody-mediated rejection (ABMR). Dr Schinstock
@MayoClinicNeph
showed worse outcomes in DSA+ABMR+ vs DSA-ABMR. The causes of microvascular inflammation can be multiple, including nonHLA or NK cells. Prognosis is worse with DSAs
#BanffCST2022
1
6
43
Updates on vaccines in transplantation
@mgh_transplant
@KottonNelson
1) New recombinant Zoster vaccine recommended to all patients prior to transplant or >12 months of those transplanted already (2 doses); 2) Pneumonoccal vaccine: all ESKD or post-tx should get 1 dose of PCV20
1
16
43
Thanks for strong contribution of
@jradne
in pathophysiology of nephrotic syndrome
@scieam
. Plasminogen is abnormally filtered into urinary space along w/ uPA, which converts it to active form of plasmin. Plasmin then activates ENaC channels & ↑ Na reabsorption
#Nephpearls
1
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Transplant
#glomerulopathy
assoc with microvascular inflammation has worse outcomes with
#kidney
graft survival of about 1 year independent of
#DSA
presence. Molecular signature consistent with ABMR.
1
22
45
1/5📌Could COVID19 vaccination trigger glomerular disease flare? What we know so far…
@MGHKidneys
Great perspective from Bomback et al. about the reported cases of glomerular disease flares upon COVID19 vaccination, in particular mRNA vaccines.
1
25
45
First randomized safety study of 44 kidney
#transplant
recipients with
#diabetes
that received
#SGLT2
inhibitor vs placebo. Encouraging results with only one case of urosepsis and significant reduction of weight at 24 weeks. Summary below
0
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How does the new 2021 race-free CKD-EPI equation to estimate GFR perform compared to measured GFR (radiolabeled marker) in kidney transplantation? The answer: both CKD-EPI with creatinine or combined creatinine-cystatin C equations performs well in kidney transplant patients.
2
10
43
Genetic testing for pts with kidney disease.
@PitchaphonN
presenting
@mgh_transplant
@MGHKidneys
approach to testing of potential transplant candidates. Huge revolution with⬇️cost and clear benefits in stratifying risk of recurrence & necessity of donor testing of relatives.
0
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Differences in the levels of HLA class II expression on endothelial cells might affect rejection risk. Exciting work from DeSerres & colleagues using various human blood-derived endothelial cells and demonstrating: HLA-DQ was the most variably expressed.
0
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Our successful approach to transplanting a simultaneous heart/kidney in a highly sensitized patient with a positive complement-dependent cytotoxic crossmatch. Post-transplant, we used a multitarget approach of T and B cell depletion, complement inhibition& IVIG. No plasmapheresis
1
3
42
Rennke reviewing the physiology of the kidney for the new
@BWHKidney
fellows. Kidneys receive the same amount of blood flow as the brain. While the brain weighs 1,400g, the kidney weighs ~300g. Furthermore, ~28g represent the glomeruli. Quite high amount for 28g!!!
5
26
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Great teaching points
@yaelheher
1) importance of 2 core
#kidney
#Transplant
biopsies to improve the sensitivity in rejection detection.2)Assessing inflammation in non-scarred areas to diagnose acute T-cell mediated rejection. 3)PAS stain to identify tubulitis (t1-3) TBM outline
0
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