Distribution of donor-specific antibodies in the cortex and the medulla of renal transplants with chronic allograft nephropathy

Bocrie, O.; Aly, Aymen Ahmed Hussein; Guignier, F.; Vega, Mathilde Funes de la; Rifle, G; Mousson, Christiane; Martin, Laurent

doi:10.1016/j.trim.2007.01.001

Cited by 24 publications

(13 citation statements)

References 11 publications

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“…In all these cases, PTC C4dϩ deposits were seen. Sera obtained at the time of the transplantectomy revealed only 16% of circulating DSA (14). This confirms a strong relationship between C4d deposits and the presence of antidonor HLA antibodies, and challenges the need to detect circulating antibodies to define CAMR.…”

Section: Discussionmentioning

confidence: 60%

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C4d-Positive Chronic Rejection: A Frequent Entity With a Poor Outcome

et al. 2007

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Section: Discussionmentioning

confidence: 60%

“…In the 31 cases of CR reported by Worthington et al, the percentage of C4dϩ analyzed by IMP was 42% (10), whereas Bocrie et al found 75% in 12 CR cases (14). Mauyyedi et al looked at C4d in 38 cases of chronic rejection and found that 61% of them had PTC C4dϩ (2).…”

Section: Discussionmentioning

confidence: 99%

C4d-Positive Chronic Rejection: A Frequent Entity With a Poor Outcome

et al. 2007

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“…The potential mechanisms supporting this observation warrant further study but would be consistent with increases in measurable alloimmune activity. [22][23][24][25] These data are difficult to interpret conclusively, because the reason for nephrectomy is not known, and we cannot surmise that avoiding nephrectomy would abrogate this risk. These observations must be weighed against the potential survival benefits that have been reported with other studies of allograft nephrectomy.…”

Section: Discussionmentioning

confidence: 98%

“…Nephrectomy can result in an increase in PRA [22][23][24][25] as well as negatively affect subsequent graft survival. 26 Therefore, we specifically examined the effect of RMM in patients with and without nephrectomy of the first allograft occurring before the second transplant and found that class 2 RMM carried increased hazard for DCGL and ACGL, specifically in patients who were nephrectomized.…”

Section: Discussionmentioning

confidence: 99%

Re-Examining Risk of Repeated HLA Mismatch in Kidney Transplantation

Tinckam

Rose

Hariharan

et al. 2016

JASN

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Kidney retransplantation is a risk factor for decreased allograft survival. Repeated mismatched HLA antigens between first and second transplant may be a stimulus for immune memory responses and increased risk of alloimmune damage to the second allograft. Historical data identified a role of repeated HLA mismatches in allograft loss. However, evolution of HLA testing methods and a modern transplant era necessitate re-examination of this role to more accurately risk-stratify recipients. We conducted a contemporary registry analysis of data from 13,789 patients who received a second kidney transplant from 1995 to 2011, of which 3868 had one or more repeated mismatches. Multivariable Cox proportional hazards modeling revealed no effect of repeated mismatches on all-cause or death-censored graft loss. Analysis of predefined subgroups, however, showed that any class 2 repeated mismatch increased the hazard of death-censored graft loss, particularly in patients with detectable panel-reactive antibody before second transplant (hazard ratio [HR], 1.15; 95% confidence interval [95% CI], 1.02 to 1.29). Furthermore, in those who had nephrectomy of the first allograft, class 2 repeated mismatches specifically associated with all-cause (HR, 1.30; 95% CI, 1.07 to 1.58) and death-censored graft loss (HR, 1.41; 95% CI, 1.12 to 1.78). These updated data redefine the effect of repeated mismatches in retransplantation and challenge the paradigm that repeated mismatches in isolation confer increased immunologic risk. We also defined clear recipient categories for which repeated mismatches may be of greater concern in a contemporary cohort. Additional studies are needed to determine appropriate interventions for these recipients. 27: 283327: -284127: , 201627: . doi: 10.1681 Kidney retransplantation is generally viewed to increase risk for immunologic damage and graft loss. The increased risk is attributed to the formation of T and B memory cells to mismatched HLA antigens in the original donors. Re-exposure to a repeated HLA antigen mismatched (RMM) in a subsequent donor potentially invokes alloimmune memory responses, resulting in earlier allograft damage and loss. J Am Soc NephrolThe nature and magnitude of this potential risk have changed with reanalysis over time. Whereas a number of studies have described worse allograft survival when repeated antigens are mismatched at the HLA-DR locus, 1-3 with RMM at class 1 (HLA-A or -B) not influencing outcomes, others have shown a beneficial effect of RMM on graft survival 4,5 or a neutral effect. 6,7 A more recent analysis showed an effect of class 1 RMM on graft survival, with no differences seen with class 2 RMM. 8

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“…It has been shown that PRA level increases after kidney-allograft failure and immunosuppressants are stopped (10Y13), and that DSAs are often detected. It has been also suggested that DSAs are detected mainly after allograft nephrectomy because alloantibodies may be absorbed by the failed kidney (10,14,15).…”

Section: Discussionmentioning

confidence: 99%