Antibody-Mediated Acute Vascular Rejection of Kidney Allografts: Fifteen-Year Follow-up

Cubillo, B. Rodriguez; Flores, Isabel; Calvo, N.; Pascual, Alejandro; Cortes, José A.; Moreno, Mauricio; Blanco, Julia; Fructuoso, Ana Sánchez

doi:10.1016/j.transproceed.2016.09.015

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…However, in the presence of DSA this could also indicate antibody-mediate rejection. Indeed, for CD59 it seems like both graft failure and acute rejection within the first days posttransplantation are most prevalent in the presence of both pretransplant DSA and the donor CD59 risk genotype ( 39 ). Pretransplant DSA have been associated with an increased risk of early failure ( 40 ).…”

Section: Discussionmentioning

confidence: 99%

Association Between Promoter Polymorphisms in CD46 and CD59 in Kidney Donors and Transplant Outcome

et al. 2018

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Complement regulating proteins, including CD46, CD55, and CD59, protect cells against self-damage. Because of their expression on the donor endothelium, they are hypothesized to be involved in accommodation. Polymorphisms in their promoter regions may affect their expression. The aim of this study was to investigate if donor polymorphisms in complement regulating proteins influence kidney transplant outcomes. We included 306 kidney transplantations between 2005 and 2010. Five polymorphisms in the promoters of CD46, CD55, and CD59 were genotyped. A CD59 promoter polymorphism (rs147788946) in donors was associated with a lower 1-year rejection-free survival [adjusted hazard ratio (aHR) 2.18, 95% CI 1.12–4.24] and a trend toward impaired 5-year graft survival (p = 0.08). Patients receiving a kidney with at least one G allele for the CD46 promoter polymorphism rs2796267 (A/G) showed a lower rejection-free survival, though this became borderline significant after adjustment for potential confounders (aHR 1.87, 95% CI 0.96–3.65). A second CD46 promoter polymorphism (rs2796268, A/G), was also associated with a lower freedom from acute rejection in the presence of at least one G allele (aHR 1.95, 95% CI 1.03–3.68). Finally, the combined presence of both favorable genotypes of rs2796267 and rs147788946 had an additional protective effect both on acute rejection (p = 0.006) and graft survival (p = 0.03). These findings could help to identify patients who could benefit from intensified immunosuppressive therapy or novel complement inhibitory therapeutics.

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Section: Discussionmentioning

confidence: 99%

Association Between Promoter Polymorphisms in CD46 and CD59 in Kidney Donors and Transplant Outcome

et al. 2018

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“…Additionally, the study results largely emphasize the necessity of correct assessment of the AVR phenotype and are confirmatory of previous studies . While the cellular phenotype of AVR is associated with a more favourable clinical course and good response to treatment, the humoral phenotype has a detrimental effect on kidney allograft survival, especially in patients not receiving appropriate therapy .…”

Section: Discussionmentioning

confidence: 99%

Isolated v-lesion represents a benign phenotype of vascular rejection of the kidney allograft - a retrospective study

et al. 2018

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While the detrimental impact of the humoral acute vascular rejection (AVR) phenotype is recognized, the prognostic significance of isolated v-lesion (IV) remains unclear. In this retrospective single-centre study, AVR was found in 98 of 1015 patients (9.7%) who had undergone kidney transplantation in 2010-2014, with donor-specific antibodies (DSA) evaluated in all of them. The outcome of four AVR phenotypes was evaluated during median follow-up of 59 months; in 25 patients with IV, 18 with T-cell-mediated vascular rejection (TCMVR), 19 with antibody-mediated vascular rejection (AMVR) and 36 with suspected antibody-mediated rejection (sAMVR). AVR was diagnosed mainly by for-cause biopsy (81%) early after transplantation (median 19 POD) and appeared as mild-grade intimal arteritis. IV occurred in low-sensitized patients after the first transplantation (96%) in the absence of DSA. IV responded satisfactorily to treatment (88%), showed no persistence of rejection in surveillance biopsy, and had stable graft function, minimal proteinuria and excellent DCGS (96%). Contrary to that, Kaplan-Meier estimate of 3-year DCGS of AMVR was 66% (log-rank = 0.0004). Early IV represents a benign phenotype of AVR with a favourable outcome. This study prompts further research to evaluate the nature of IV before considering any change in the classification and management.

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“…During solid organ transplantation, the immune system generates a response that is attributed to rejection, which is mediated by antibodies, T cells or vascular disturbances; in this response, antibody rejection is the worst prognosis. 52,53 Immunosuppressive drugs used in transplants produce a large number of side effects, 54 including nephrotoxicity, malignancy, hypertension, diabetes and infections. Cytomegalovirus infection is one of the most common.…”

Section: Cd4+cd25+foxp3 Cd4+cd25+mentioning

confidence: 99%

Inducción de tolerancia por vía oral en trasplante de órganos y tejidos. Revisión de la Literatura

et al. 2020

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Introduction:Oral tolerance is defined as the suppression of the immune response to antigens that have been previously administered orally. The purpose of inducing oral tolerance is to avoid using immunosuppressive drugs since, considering that they are not antigen-specific, they make the host more susceptible to acquire infections and develop neoplasms. Objective: To carry out a literature review on the most relevant theoretical references regarding oral tolerance induction in organ and tissue transplantation to prove that oral tolerance is a viable alternative therapy in transplant patients. Materials and methods: A literature review was conducted in the PubMed, MEDLINE, LILACS and Embase databases using the following search strategy: publication time: no limits; publication language: English and Spanish; type of studies: case-control studies, literature and systematic reviews; search terms: "T-Lymphocytes, Regulatory", "Autoimmunity", Immunosuppression", "Immune system" and "Immune Tolerance", and their equivalents in Spanish. Results: After the initial search was completed, 719 records were retrieved; however, only 99 addressed oral tolerance induction. Once duplicate records and articles without full-text access were removed, 75 studies were included for analysis. Conclusions: Oral administration of antigens is an effective way to induce immune tolerance in transplant patients (murine models) as it eliminates the adverse effects associated with immunosuppressive therapy, which currently is the standard therapy to treat these patients worldwide.Introducción. La tolerancia oral es la supresión de la respuesta inmune a antígenos administrados con anterioridad por vía oral; su inducción tiene el propósito de evitar el uso de fármacos inmunosupresores, los cuales, dado que son poco específicos a antígenos, vuelven al huésped más susceptible de contraer infecciones y desarrollar neoplasias. Objetivos. Realizar una revisión de la literatura sobre los referentes teóricos más relevantes de la inducción de a tolerancia oral en lo que respecta al trasplante de órganos y tejidos para demostrar que el uso de esta alternativa terapéutica es viable en pacientes trasplantados. Materiales y métodos. Se realizó una revisión de la literatura en PubMed, MEDLINE, LILACS y Embase mediante la siguiente estrategia de búsqueda: periodo de publicación: sin límites; idiomas: Inglés y Español; tipo de artículos: estudios caso-control, revisiones sistemáticas y de la literatura; términos de búsqueda: "T-Lymphocytes, Regulatory", "Autoimmunity", Immunosuppression", "Immune system" and "Immune Tolerance", y sus equivalentes en español. Resultados. La búsqueda inicial arrojó 719 registros, sin embargo solo 99 abordaban la inducción de la tolerancia oral. Una vez los registros duplicados y los artículos sin acceso a texto completo fueron removidos, se incluyeron 72 estudios en la revisión. Conclusiones. La administración oral de antígenos es una opción efectiva para inducir tolerancia inmunológica en pacientes trasplantados (modelos murinos...

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Antibody-Mediated Acute Vascular Rejection of Kidney Allografts: Fifteen-Year Follow-up

Cited by 5 publications

References 9 publications

Association Between Promoter Polymorphisms in CD46 and CD59 in Kidney Donors and Transplant Outcome

Association Between Promoter Polymorphisms in CD46 and CD59 in Kidney Donors and Transplant Outcome

Isolated v-lesion represents a benign phenotype of vascular rejection of the kidney allograft - a retrospective study

Inducción de tolerancia por vía oral en trasplante de órganos y tejidos. Revisión de la Literatura

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