British Society for Histocompatibility &amp; Immunogenetics and British Transplantation Society Guidelines for the Detection and Characterisation of Clinically Relevant Antibodies in Allotransplantation

Howell, W. Martin; Harmer, A.; Briggs, David; Dyer, Philip A.; Fuggle, Susan V.; Martin, Susan; Sinnott, Paul J.; Smith, John D.; Taylor, Craig; Vaughan, R. W.

doi:10.1111/j.1744-313x.2010.00955.x

Cited by 28 publications

(18 citation statements)

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“…Although recommended , limited data exist regarding DSA monitoring and although small in numbers, monitoring DSA in our population detected not only that the development of DSA preceded graft dysfunction but where early intervention with intensified IS occurred, there appeared to be an increased likelihood of reduction in DSA levels and stabilization of graft function. The aforementioned paper by Hoshino recommends DSA monitoring on a monthly basis, particularly when IS reduction occurs .…”

Section: Discussionmentioning

confidence: 66%

Pediatric kidney recipients may benefit from monitoring for donor‐specific antibodies

Athavale

Worthington

Webb

et al. 2014

Pediatric Transplantation

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There are limited data regarding the presence of DSAs and their effect on graft function in pediatric renal transplantation. The role for serial DSA monitoring in routine clinical practice is unclear. All patients attending a regional transplant clinic were tested for DSAs, measured using Luminex single/mixed antigen beads. Any patient having a positive result subsequently underwent historic testing on samples previously obtained. DSA-positive patients underwent prospective monitoring of DSAs, and correlation with clinical events was studied. Nine of a total of 50 patients (18%) were DSA-positive, of whom six had graft dysfunction. The DSA-positive cohort had significantly increased episodes of AR (p = 0.01). There were two graft losses in the DSA-positive group and none in the DSA-negative group. Eight of the DSA-positive group had potentially reduced exposure to IS because of either adherence issues or clinical indications. DSAs were associated with increased risk of rejection. There appears to be a role for serial monitoring of DSAs in patients where there has been a reduced exposure to IS so that early intervention with optimized IS can be considered.

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Section: Discussionmentioning

confidence: 66%

Pediatric kidney recipients may benefit from monitoring for donor‐specific antibodies

Athavale

Worthington

Webb

et al. 2014

Pediatric Transplantation

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“…There is an ongoing discussion about the valid threshold levels that define antibody-mediated rejection. Most often, a mean fluorescence intensity (MFI) >1,000 is considered as positive for HLA antibodies [40]. The British Society of Transplantation has even suggested testing for DSAs every 3 months after kidney and pancreas transplantation [40].…”

Section: Detection Of Hla Antibodiesmentioning

confidence: 99%

“…Most often, a mean fluorescence intensity (MFI) >1,000 is considered as positive for HLA antibodies [40]. The British Society of Transplantation has even suggested testing for DSAs every 3 months after kidney and pancreas transplantation [40]. The rates of DSAs in routine monitoring have been published to be between 2.5 and 24 % [41,42].…”

Section: Detection Of Hla Antibodiesmentioning

confidence: 99%

Acute and chronic antibody-mediated rejection in pediatric kidney transplantation

et al. 2014

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Acute antibody-mediated rejection is a diagnostic challenge in renal transplantation medicine. However, it is an important diagnosis to make, since chronic antibody-mediated rejection (CAMR) is the main cause of long-term graft loss. Antibody-mediated rejection is diagnosed by detecting donorspecific antibodies (DSAs) in the blood in combination with observing typical histomorphological signs in kidney biopsy, as described in the Banff classification. Therapy is based on the removal of DSAs by administering intravenous immunoglobulins (IVIGs), plasmapheresis, or immunoadsorption. Reoccurrence of antibodies is diminished by the use of rituximab, increased immunosuppression, and in some cases additional experimental substances. A combination of these techniques has been shown to be successful in the majority of cases of acute and chronic antibody-mediated rejection. Routine DSA monitoring is warranted for early detection of antibody-mediated rejection.

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“…Several studies have suggested that early detection of dnDSA can help to identify patients at increased risk of graft loss . Current guidelines for post‐transplant monitoring recommend routine monitoring at regular intervals, and at times of renal biopsy for graft dysfunction . When dnDSA are detected and there is biopsy evidence of AMR, there is consensus about the need for aggressive therapy.…”

Section: Introductionmentioning

confidence: 99%

Results of early treatment for de novo donor‐specific antibodies in pediatric kidney transplant recipients in a cross‐sectional and longitudinal cohort

Charnaya

Tuchman

Moudgil

2018

Pediatric Transplantation

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The development of dnDSA anti-HLA antibodies has been shown to be a significant risk factor for graft failure. In 2008, we instituted a routine protocol of standardized monitoring and treatment of dnDSA in pediatric kidney transplant recipients. Of 67 first-time pediatric kidney transplant recipients, 26 (38%) developed dnDSA after 1.36 (IQ 1-2.14) years. Coefficient of variance of tacrolimus, a surrogate marker of non-adherence, was found to be the single most important risk factor for dnDSA development. Overall, there was a significant reduction in dnDSA with treatment in 19 (76%) children. No difference in graft survival and estimated glomerular filtration rate was noted between dnDSA negative and those treated for dnDSA. There was an increased risk of hospitalization in those treated for dnDSA. This study suggests that early detection and treatment of dnDSA can help to prevent graft failure and preserve graft function in the short term. Future studies and longer follow-up are needed to fully elucidate the effect of early detection and treatment of dnDSA in pediatric kidney transplant recipients.

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British Society for Histocompatibility & Immunogenetics and British Transplantation Society Guidelines for the Detection and Characterisation of Clinically Relevant Antibodies in Allotransplantation

Cited by 28 publications

References 0 publications

Pediatric kidney recipients may benefit from monitoring for donor‐specific antibodies

Pediatric kidney recipients may benefit from monitoring for donor‐specific antibodies

Acute and chronic antibody-mediated rejection in pediatric kidney transplantation

Results of early treatment for de novo donor‐specific antibodies in pediatric kidney transplant recipients in a cross‐sectional and longitudinal cohort

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