W. James Chon

Publications

• Renal Allograft Rejection: Diagnosis and Treatment

  W. James Chon, Daniel C. Brennan

  UpToDate. 02/2012;

• Leflunomide in renal transplantation.

  W James Chon, Michelle A Josephson

  Expert review of clinical immunology. 05/2011; 7(3):273-81.

  Leflunomide is a synthetic isoxazole-derivative drug that possesses both immunosuppressive and antiviral properties. Although its only US FDA-approved indication is for the treatment of rheumatoid arthritis, accumulating clinical experience in addition to animal study data makes it an appealing opti... [more] Leflunomide is a synthetic isoxazole-derivative drug that possesses both immunosuppressive and antiviral properties. Although its only US FDA-approved indication is for the treatment of rheumatoid arthritis, accumulating clinical experience in addition to animal study data makes it an appealing option for patients who are in need of reduction of immunosuppression in the setting of resistant cytomegalovirus infection or BK virus nephropathy, or in renal transplant recipients with chronic allograft dysfunction. While concern over adverse effects such as hepatotoxicity and hemolytic anemia cannot be ignored and there has yet to be a prospective randomized trial for its use in transplantation, its careful usage under close monitoring may provide the best chance for patients who risk allograft rejection during the time of immunosuppressive reduction as they attempt to eradicate BK virus or cytomegalovirus. At the present time, its use as a first-line agent in lieu of mycophenolate mofetil or sirolimus cannot be recommended.
• 2.24

  Impact points

  Changing attitudes toward influenza vaccination in U.S. Kidney transplant programs over the past decade.

  W James Chon, Pradeep V Kadambi, Robert C Harland, J Richard Thistlethwaite, Bradford L West, Suneel Udani, Rajiv Poduval, Michelle A Josephson

  Clinical journal of the American Society of Nephrology : CJASN. 09/2010; 5(9):1637-41.

  Influenza infection in transplant recipients is often associated with significant morbidity. Surveys were conducted in 1999 and 2009 to find out if the influenza vaccination practices in the U.S. transplant programs had changed over the past 10 years. In 1999, a survey of the 217 United Network for ... [more] Influenza infection in transplant recipients is often associated with significant morbidity. Surveys were conducted in 1999 and 2009 to find out if the influenza vaccination practices in the U.S. transplant programs had changed over the past 10 years. In 1999, a survey of the 217 United Network for Organ Sharing-certified kidney and kidney-pancreas transplant centers in the U.S. was conducted regarding their influenza vaccination practice patterns. A decade later, a second similar survey of 239 transplant programs was carried out. The 2009 respondents, compared with 1999, were more likely to recommend vaccination for kidney (94.5% versus 84.4%, P = 0.02) and kidney-pancreas recipients (76.8% versus 48.5%, P < 0.001), family members of transplant recipients (52.5% versus 21.0%, P < 0.001), and medical staff caring for transplant patients (79.6% versus 40.7%, P < 0.001). Physicians and other members of the transplant team were more likely to have been vaccinated in 2009 compared with 1999 (84.2% versus 62.3% of physicians, P < 0.001 and 91.2% versus 50.3% of nonphysicians, P < 0.001). Our study suggests a greater adoption of the Centers for Disease Control and Prevention influenza vaccination guidelines by U.S. transplant programs in vaccinating solid-organ transplant recipients, close family contacts, and healthcare workers.
• 5.15

  Impact points

  Smoking-does it "burn" the kidney transplant?

  Pradeep V Kadambi, W James Chon, Michelle A Josephson

  American journal of kidney diseases : the official journal of the National Kidney Foundation. 05/2010; 55(5):817-9.

• Investigational methods in the diagnosis of acute renal allograft rejection

  W. James Chon, Daniel C. Brennan

  UpToDate. 01/2009;
• 7.69

  Impact points

  On the intraoperative molecular status of renal allografts after vascular reperfusion and clinical outcomes.

  Yingyos Avihingsanon, Naili Ma, Martha Pavlakis, W James Chon, Marc E Uknis, Anthony P Monaco, Christiane Ferran, Isaac Stillman, Asher D Schachter, Christina Mottley, Xin Xiao Zheng, Terry B Strom

  Journal of the American Society of Nephrology : JASN. 07/2005; 16(6):1542-8.

  Many hypothesize that subtle inflammation and immune activity detected in the intraoperative period are linked to adverse postkidney transplant clinical outcomes. To this end, renal allografts were analyzed for expression of pro-inflammatory, inflammation-induced adhesion molecules, immune activatio... [more] Many hypothesize that subtle inflammation and immune activity detected in the intraoperative period are linked to adverse postkidney transplant clinical outcomes. To this end, renal allografts were analyzed for expression of pro-inflammatory, inflammation-induced adhesion molecules, immune activation as well as anti-apoptotic genes expressed 15 min after vascular reperfusion (zero-hour) to determine whether this analysis can aid in predicting the occurrence of delayed graft function (DGF), acute rejection (AR), and the quality of graft function at 6 mo. Intraoperative biopsies were obtained from 75 consecutively performed renal allografts in which consent was obtained 15 min after vascular reperfusion. These biopsies were analyzed by quantitative real-time PCR for transcription of 15 select genes and by standard histopathology. Posttransplant clinical outcomes were also analyzed in respect to intraoperative transcriptional profiles and clinical parameters available at the time of transplantation. This study demonstrates that a limited and hypothesis-driven PCR-based transcriptional profile of the zero-hour kidney biopsy predicts posttransplant clinical outcomes including DGF, early AR, and the quality of renal function 6 mo posttransplantation. For some clinical endpoints, the combined use of molecular analysis and established clinical indicators available at the time of transplantation further enhances the quality of prognosis. The transcriptional profiling data provide absolutely essential data to the predictive models, particularly with respect to AR and renal function 6 mo posttransplantation.
• 6.19

  Impact points

  Rapamycin is an effective inhibitor of human renal cancer metastasis.

  Fu L Luan, Ruchuang Ding, Vijay K Sharma, W James Chon, Milagros Lagman, Manikkam Suthanthiran

  Kidney international. 04/2003; 63(3):917-26.

  Rapamycin is an effective inhibitor of human renal cancer metastasis. BACKGROUND: Human renal cell cancer (RCC) is common and is 10 to 100 times more frequent in patients with end-stage renal disease (ESRD) and candidates for renal transplantation. Treatment of metastatic RCC is largely ineffective ... [more] Rapamycin is an effective inhibitor of human renal cancer metastasis. BACKGROUND: Human renal cell cancer (RCC) is common and is 10 to 100 times more frequent in patients with end-stage renal disease (ESRD) and candidates for renal transplantation. Treatment of metastatic RCC is largely ineffective and is further undermined by immunosuppressive therapy in transplant recipients. A treatment regimen that prevents transplant rejection while constraining RCC progression would be of high value. METHODS: We developed a human RCC pulmonary metastasis model using human RCC 786-O as the tumor challenge and the severe combined immunodeficient (SCID) beige mouse as the host. We explored the effect of rapamycin, cyclosporine, or rapamycin plus cyclosporine on the development of pulmonary metastases and survival. The effects of the drugs on tumor cell growth, apoptosis, and expression of vascular endothelial growth factor (VEGF-A) and transforming growth factor beta1 (TGF-beta1) were also investigated. RESULTS: Rapamycin reduced, whereas cyclosporine increased, the number of pulmonary metastases. Rapamycin was effective in cyclosporine-treated mice, and rapamycin or rapamycin plus cyclosporine prolonged survival. Rapamycin growth arrested RCC 786-O at the G1 phase and reduced VEGF-A expression. Immunostaining of lung tissues for von Willebrand factor was minimal and circulating levels of VEGF-A and TGF-beta1 were lower in the rapamycin-treated mice compared to untreated or cyclosporine-treated mice. CONCLUSION: Our findings support the idea that rapamycin may be of value for patients with RCC and that its antitumor efficacy is realized by cell cycle arrest and targeted reduction of VEGF-A and TGF-beta1. A regimen of rapamycin and cyclosporine, demonstrated to be effective in reducing acute rejection of renal allografts, may prevent RCC progression as well, and has the potential to prevent mortality due to RCC in patients with ESRD who have received renal allografts.