Biomarkers of tolerance

Gökmen, Refik; Hernandez-Fuentes, Maria P.

doi:10.1097/mot.0b013e3283636fd5

Cited by 15 publications

(14 citation statements)

References 41 publications

(28 reference statements)

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“…In patients who have mixed cellular rejection and ABMR, cell depletion and signal blockade therapies may also be more successful earlier in their course. The molecular signature for tolerance is currently being studied [110,111] and may possibly be induced by specific immunomodulators, suggesting that there may be a potential for induction of operational tolerance, which would be the ultimate prevention of ABMR.…”

Section: Discussionmentioning

confidence: 98%

Antibody-Mediated Rejection in Pediatric Kidney Transplantation: Pathophysiology, Diagnosis, and Management

Singh

Sarwal

2015

Drugs

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Kidney transplant is the preferred treatment of pediatric end-stage renal disease. One of the most challenging aspects of pediatric kidney transplant is the prevention and treatment of antibody-mediated rejection (ABMR), which is one of the main causes of graft dysfunction and early graft loss. Most challenges are similar to those faced in adult kidney transplants; however, factors unique to the pediatric realm include naivety of the immune system and the small number of studies and randomized controlled trials available when considering pharmacological treatment options. Here, we present a case of ABMR in a pediatric patient and a review of the pathophysiology, diagnosis, and management of ABMR. ABMR in pediatric kidney transplant continues to be a frustrating condition to treat because (1) there still remain many unidentified potential antigens leading to ABMR, (2) children and adults are at different stages of their immune system development, and, thus, (3) the full pathophysiology of alloimmunity is still not completely understood, and (4) the efficacy and safety of treatment in adults may not be directly translated to children. As we continue to gain a better understanding towards the precise alloimmune mechanism that drives a particular ABMR, we can also improve pharmacotherapeutic choices. With continued research, they will become more precise in treating a particular mechanism versus using a broad scope of immunosuppression such as steroids. However, there is much more to be uncovered, such as identifying more non-human leukocyte antigens and their role in alloimmunity, determining the exact mechanism of adults achieving complete operational tolerance, and understanding the difference between pediatric and adult transplant recipients. Making strides towards a better understanding of these mechanisms will lead to continued efficacy and safety in treatment of pediatric ABMR.

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Section: Discussionmentioning

confidence: 98%

Antibody-Mediated Rejection in Pediatric Kidney Transplantation: Pathophysiology, Diagnosis, and Management

Singh

Sarwal

2015

Drugs

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“…La progresiva mejoría en resultados de supervivencia de pacientes con trasplante hepático 4,[8][9][10] ha dado lugar a la preocupación respecto de la morbimortalidad relacionada con el uso crónico de medicación inmunosupresora. 3,[8][9][10][11] Cargas VEB (log) Dosaje FK (ng/ml) Desde los primeros reportes de buena evolución a pesar de la mala adherencia al tratamiento, 1,2 varios centros describen sus resultados respecto de la tolerancia operacional, pero la aplicabilidad de estas experiencias está limitada por la actual imposibilidad de predecir quiénes son candidatos a tolerar y quiénes requieren inmunosupresión sostenida.…”

Section: Discussionunclassified

“…3,[8][9][10][11] Cargas VEB (log) Dosaje FK (ng/ml) Desde los primeros reportes de buena evolución a pesar de la mala adherencia al tratamiento, 1,2 varios centros describen sus resultados respecto de la tolerancia operacional, pero la aplicabilidad de estas experiencias está limitada por la actual imposibilidad de predecir quiénes son candidatos a tolerar y quiénes requieren inmunosupresión sostenida. 5 Si bien algunos autores discuten si suspender la medicación implica una mejoría de la calidad de vida de los pacientes trasplantados, ya que no garantiza el fin del monitoreo, sino que demanda aún más y frecuentes controles de seguimiento, 12 la mayoría coincide en las ventajas que plantearía minimizar y suspender la inmunosupresión en cuanto a las complicaciones relativas a esta medicación.…”

Section: Discussionunclassified

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Tolerancia operacional en un receptor pediátrico de trasplante hepático. Caso clínico

et al. 2015

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“…Immunological tolerance can be assessed by identifying and enumerating the constituents of the immune system as well as by monitoring their functional capacity with regards to the immune response. Historically, a number of methodologies have been employed to assess immunologic tolerance or the onset of organ rejection (Gokmen & Hernandez-Fuentes, 2013; Najafian et al, 2006; Sawitzki et al, 2011). …”

Section: Monitoring Regulatory Cells and Other Immune Cell Subsetsmentioning

confidence: 99%

Flow Cytometry and Solid Organ Transplantation: A Perfect Match

Maguire

Tario

Shanahan

et al. 2014

Immunological Investigations

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In the field of transplantation, flow cytometry serves a well-established role in pre-transplant crossmatching and monitoring immune reconstitution following hematopoietic stem cell transplantation. The capabilities of flow cytometers have continuously expanded and this combined with more detailed knowledge of the constituents of the immune system, their function and interaction and newly developed reagents to study these parameters have led to additional utility of flow cytometry-based analyses, particularly in the post-transplant setting. This review discusses the impact of flow cytometry on managing alloantigen reactions, monitoring opportunistic infections and graft rejection and gauging immunosuppression in the context of solid organ transplantation.

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Biomarkers of tolerance

Cited by 15 publications

References 41 publications

Antibody-Mediated Rejection in Pediatric Kidney Transplantation: Pathophysiology, Diagnosis, and Management

Antibody-Mediated Rejection in Pediatric Kidney Transplantation: Pathophysiology, Diagnosis, and Management

Tolerancia operacional en un receptor pediátrico de trasplante hepático. Caso clínico

Flow Cytometry and Solid Organ Transplantation: A Perfect Match

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