Donor-Specific Anti-HLA Antibodies After Bone-Graft Transplantation. Impact on a Subsequent Renal Transplantation: A Case Report

Mosconi, Giovanni; Baraldi, Olga; C, Fantinati; Panicali, Laura; Veronesi, Maria Cristina; Cappuccilli, Maria; Corsini, Serena; Zanelli, Paola; Bassi, Anna Maria; Buscaroli, Andrea; Feliciangeli, G.; Stefoni, Sergio

doi:10.1016/j.transproceed.2009.02.059

Cited by 8 publications

(7 citation statements)

References 26 publications

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“…This may suggest that trace amounts of MHC molecules are clinically not relevant. Despite the frequent use of human tissue products worldwide in a variety of medical specialties, formation of alloantibodies complicating future solid organ transplantation has rarely been reported for fresh‐frozen or cryopreserved bone . After using freeze‐dried or solvent dehydrated bone allografts from single or multiple donors for dental applications, such incidences have not been reported at all.…”

Section: Discussionsupporting

confidence: 41%

“…Despite the frequent use of human tissue products worldwide in a variety of medical specialties, formation of alloantibodies complicating future solid organ transplantation has rarely been reported for fresh-frozen or cryopreserved bone. 12,31 After using freeze-dried or solvent dehydrated bone allografts from single or multiple donors for dental applications, such incidences have not been reported at all. In our study, we did not detect any MHC1 molecules in the individual batches of bone allograft materials using ELISA.…”

Section: Discussionmentioning

confidence: 99%

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Histological and immunohistochemical comparison of two different allogeneic bone grafting materials for alveolar ridge reconstruction: A prospective randomized trial in humans

Solakoglu

Götz

Heydecke

et al. 2019

Clin Implant Dent Rel Res

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BackgroundPreclinical studies have hypothesized a possible immunological reponse to allogeneic materials due to detection of remnants of potential immunogenic molecules. However, their impact on integration, bone remodeling and immunological reaction after the augmentation procedure is largely unknown and a direct correlation of analytical data and evaluation of human biopsies is missing.PurposeThe present study aimed to compare two commercially available allogeneic materials regarding their content of cellular remnants as well as the bone remodeling, and integration and potential immunologic reactions on a histological and immunohistochemical level, integrating also in vitro analytical evaluation of the specific batches that were used clinically.Materials and MethodsTwenty patients were randomly assigned to treatment with Maxgraft or Puros for lateral ridge augmentation in a two‐stage surgery. After a mean healing period of 5 months, implants were placed and biopsies were taken for histological, immunhistochemical, and histomorphometrical evaluation regarding bone remodeling and inflammation, protein concentrations in vitro and the presence of MHC molecules of the same batches used clinically.ResultsNo differences in clinical outcome, histological, immunohistochemical, and in vitro protein analysis between the two bone grafting materials were observed. Active bone remodeling, amount of newly formed bone, and residual grafting material was independent of the materials used, but varied between subjects. MHC1 residues were not detected in any sample.ConclusionsWithin the limitations of this study, both tested materials yielded equivalent results in terms of clinical outcome, new bone formation, and lack of immunological potential on a histological and immunohistochemical level.

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Section: Discussionsupporting

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Histological and immunohistochemical comparison of two different allogeneic bone grafting materials for alveolar ridge reconstruction: A prospective randomized trial in humans

Solakoglu

Götz

Heydecke

et al. 2019

Clin Implant Dent Rel Res

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“…A second report of a patient developing DSA, also following osteosarcoma resection and tibial reconstruction with allogenic bone graft, has been reported. While this patient had a concomitant blood transfusion, it is possible that the large quantity of bone used was a factor in inducing allosensitization .…”

Section: Discussionmentioning

confidence: 99%

“…Bone grafts are traditionally thought to represent a low immunological risk of alloimmunization, perhaps due to uncertainty surrounding viability of remaining marrow and antigen‐presenting cells in graft material. However, there is a small body of evidence beginning to accumulate that suggests a previously unrecognized risk is associated with bone grafts, which may be clinically important for some patients . We present an unusual case of a patient who unexpectedly developed a broad range of anti‐HLA antibodies following orthopedic surgery where a bone graft was deployed as part of the intraoperative technique.…”

Section: Introductionmentioning

confidence: 99%

Allosensitization Following Bone Graft

O’Sullivan

Battle

Zahra

et al. 2017

American Journal of Transplantation

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It is recognized that patients may become sensitized to donor-specific HLA antigens as a result of previous antigenic exposures, classically through previous transplantation, pregnancy, or blood transfusion. We present an unusual case of a patient who unexpectedly developed a range of anti-HLA antibodies following orthopedic surgery where a bone graft was deployed intraoperatively. We describe the case of a 52-year-old man awaiting a renal transplantation, undergoing elective orthopedic surgery requiring a small-volume bone graft. His postoperative antibody profile was found to be substantially changed compared to his previous negative samples, with the presence of HLA-DR, DQ, and DP specificities, at levels that would be likely to give a positive flow cytometry crossmatch and therefore according to local procedures required listing as unacceptable antigens for organ allocation. We perform a literature review of all previous cases of allosensitization following bone graft. This case is the first to demonstrate allosensitization following minor surgery with ;low-volume bone graft. Previous evidence is very limited and pertains only to massive osteochondral surgery for trauma or malignancy, and is confounded by potential concomitant blood transfusion. Clinicians should be aware of the risk of allosensitization where bone grafts are used.

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“…While previous studies have observed sensitization in the context of bone allografting, 6,7,[15][16][17] this is the first study to our knowledge that has assessed the relationship of postoperative sensitization to clinical and patient outcomes. While no significant association was found between donor HLA sensitization and outcomes, questions remain regarding how immunogenic materials are introduced during surgery, the effect sensitization has on subsequent allograft procedures with donors expressing cross-reactive HLA antigens, and the persistence of the HLA antibodies formed after bone allografting.…”

Section: Discussionmentioning

confidence: 85%

Donor-Specific Human Leukocyte Antigen Antibody Formation After Allograft Glenoid Reconstruction Occurs But Does Not Impact Clinicoradiographic Outcomes

Liwski

Wong

2021

Am J Sports Med

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Background: Recurrent shoulder instability is a prevalent condition, with glenoid bone loss as a common cause. Arthroscopic repair using distal tibial allografts provides long-lasting treatment by restoring glenoid surface area and presumably avoids risks of sensitization against donor human leukocyte antigen (HLA). Two case studies have challenged this assumption, suggesting that small bone allografts are able to induce host adaptive immune responses to donor HLA. The incidence of small bone allograft HLA sensitization and its effects on resorption and patient outcomes are unclear. Purpose/Hypothesis: The purpose was to assess the rate of sensitization against donor HLA after distal tibial allograft procedures for shoulder instability due to glenoid bone loss and to find whether HLA sensitization negatively affects patient-reported and radiographic outcomes. We hypothesized that sensitized patients would have worse radiographic and self-reported outcomes compared with nonsensitized patients. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 71 patients with a mean age of 28.85 years (range, 13.58-61.31 years) were enrolled, with 58 patients submitting sufficient pre- and postoperative blood samples for HLA antibody testing. In patients who developed HLA antibodies postoperatively, donor HLA typing was used to confirm donor-specific sensitization. Pre- and postoperative computerized tomography scans (0.9 ± 0.8 years follow-up) were used to grade resorption based on the modified Zhu resorption grade classification (ie, grade 0 = no resorption; grade 1 = less than 25% resorption; grade 2 = between 25% and 50% resorption; and grade 3 = larger than 50% resorption). The Western Ontario Shoulder Instability Index outcome scores were obtained preoperatively and at regular postoperative appointments. Resorption and outcome data were compared between sensitized and nonsensitized patients using the Fisher exact test, independent 2-tailed Student t tests, and the Wilcoxon rank-sum test to determine the effect of HLA sensitization on radiographic and patient-reported outcomes. Results: A total of 7 (12.1%) patients with sufficient HLA samples were sensitized against donor HLA postoperatively. Sensitized patients did not have significantly higher rates of resorption (21.9% vs 14.3%, 21.9% vs 28.6%, 43.8% vs 28.6%, and 12.5% vs 28.6% for respective resorption grades 0-3; P = .67; α = .05). Self-reported outcomes were not statistically significant between sensitized and nonsensitized patients (24.9 ± 27.61 vs 40.16 ± 18.99; P = .37; α = .05) and did not differ significantly based on resorption grade (47.4 ± 0.0 vs 55.2 ± 18.8, 30.4 ± 15.8 vs 39.9 ± 20.9, 41.2 ± 0.0 vs 39.1 ± 13.1, and -24.9 ± 0 vs 24.4 ± 19.6 for resorption grades 0-3; P > .05; α = .05). Conclusion: Sensitization against donor HLA after small bone graft allografting was not previously considered but has been brought to light as a possibility. Aside from potential complications for future organ transplants, HLA sensitization does not introduce a risk for adverse outcomes or higher grades of resorption compared with nonsensitized patients after small bone allografting for shoulder instability.

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Donor-Specific Anti-HLA Antibodies After Bone-Graft Transplantation. Impact on a Subsequent Renal Transplantation: A Case Report

Cited by 8 publications

References 26 publications

Histological and immunohistochemical comparison of two different allogeneic bone grafting materials for alveolar ridge reconstruction: A prospective randomized trial in humans

Histological and immunohistochemical comparison of two different allogeneic bone grafting materials for alveolar ridge reconstruction: A prospective randomized trial in humans

Allosensitization Following Bone Graft

Donor-Specific Human Leukocyte Antigen Antibody Formation After Allograft Glenoid Reconstruction Occurs But Does Not Impact Clinicoradiographic Outcomes

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