Antibody removal and subsequent transplantation of a highly sensitised paediatric renal patient

Bevan, D. J.; Carey, Barbara; Lea, C K; Vaughan, R. W.; Rigden, S. P. A.; Higgins, Robert; Hendry, Bruce; Koffman, C. G.; Bewick, M.

doi:10.1007/bf00336394

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…They have been used as a preemptive strategy to prevent potential rejection episodes [36, [73][74][75]. They have also been used to reverse established antibody-mediated rejection [76 -83].…”

Section: Pph/plasma Exchange (Pe)mentioning

confidence: 99%

Humoral Theory of Transplantation: Mechanism, Prevention, and Treatment

2005

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Section: Pph/plasma Exchange (Pe)mentioning

confidence: 99%

Humoral Theory of Transplantation: Mechanism, Prevention, and Treatment

2005

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“…3). It was suggested that low titer antiidiotypic IgG antibodies were preferably bound to protein A, releasing more free anti‐HLA antibodies into the circulation of the patient ( 12). Pretransplant antibody screening with in vitro and in vivo test IA seems to be mandatory for successful transplantation of highly HLA sensitized patients.…”

Section: Humoral Immune Systemmentioning

confidence: 99%

Immunoadsorption as a Tool for the Immunomodulation of the Humoral and Cellular Immune System in Autoimmune Disease

Braun

Risler

1999

Therapeutic Apheresis

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Immunoadsorption onto staphylococcal protein A is a newly developed semiselective extracorporeal adsorption technique for immunoglobulins applied in patients suffering from severe autoimmune disease. Its effect on the humoral and cellular immune system was investigated using standard immunological assays. The elimination capacity for total IgG and IgG subclasses 1, 2, and 4 was more than 90% but for subclass IgG3 varied between 30 and 90%. Autoantibodies, e.g., anti‐dsDNA, anti‐glomerular basement membrane (anti‐GBM), anti‐cardiolipin, and anti‐human leukocyte antigen (anti‐HLA) antibodies, were eliminated in comparable amounts. The affinity of protein A for circulating immune complexes (CIC) was 300 times greater than for soluble IgG. HLA‐II expression on monocytes and T lymphocytes was reduced over time during repeated IAs (IA). The number of activated T lymphocytes declined while the percentage of naive T cells increased. A diminished CD4/CD8 ratio normalized during IA treatment. These results indicate that IA actively modulates the humoral as well as the cellular immune system in addition to its immunoglobulin reducing effect.

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Cytomegalovirus‐associated chorioretinitis after liver transplantation: case report and review of the literature

Egli

Bergamin

Müllhaupt

et al. 2007

Transplant Infectious Dis

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A cytomegalovirus (CMV) donor positive/recipient negative liver transplant recipient developed CMV syndrome with presumed colitis 2 weeks after discontinuing the standard 3 months of valganciclovir prophylaxis. Treatment with intravenous ganciclovir (GCV) reduced, but did not clear, CMV replication. A CMV UL97 mutation (M460V) conferring GCV resistance was identified. Reduction of immunosuppression was followed by rapidly rising lymphocyte counts as well as by clearance of CMV viremia and of clinical symptoms. However, bilateral chorioretinitis was diagnosed 2 weeks later and treated with foscarnet and cidofovir. Then, right eye vitritis occurred necessitating vitrectomy due to a partially rhegmatogeneous retinal detachment. Because chorioretinitis-vitritis after rising lymphocyte counts and clearance of CMV viremia was strongly suggestive of an immune reconstitution syndrome (IRS)-like disease, we investigated CMV-specific T-cells in the peripheral blood available during follow-up. We found strong CD8(+) but only low CD4(+) T-cell responses (4.77% vs.<0.1%) to the CMV immediate early pp72, while responses to CMV-lysate or CMV-pp65 (CD4(+) <0.01%; CD8(+)<0.01%) were low. Over 16 weeks of follow-up, pp72-specific CD8(+) responses declined, while responses to pp65 gradually increased (CD4(+) 0.16%; CD8(+) 0.76%) indicating a slowly adapting CMV-specific cellular T-cell response. Review of 12,653 published liver transplant patients identified only 14 (0.1%) reported cases of CMV-associated chorioretinitis at a median 41.7 weeks post transplant. CMV-associated opthalmologic complications late post transplantation may possibly involve 2 different entities of cytopathic retinitis and IRS-like chorioretinitis-vitritis.

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Antibody removal and subsequent transplantation of a highly sensitised paediatric renal patient

Cited by 3 publications

References 5 publications

Humoral Theory of Transplantation: Mechanism, Prevention, and Treatment

Humoral Theory of Transplantation: Mechanism, Prevention, and Treatment

Immunoadsorption as a Tool for the Immunomodulation of the Humoral and Cellular Immune System in Autoimmune Disease

Cytomegalovirus‐associated chorioretinitis after liver transplantation: case report and review of the literature

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