Immunological monitoring of posttransplant allograft sensitization following living related donor renal transplantation

Panigrahi, Ashutosh; Deka, Roopam; Bhowmik, D; Tiwari, Suresh; Nk, Mehra

doi:10.1016/j.transproceed.2004.05.072

Cited by 15 publications

(9 citation statements)

References 12 publications

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“…1,11,[22][23][24][25][26] However, percent PRA alone is insufficient to identify which patients may be at the highest risk for post-HTx antibody-mediated rejection. 27 It is the presence of donor-specific antibodies that increases incremental risk.…”

Section: Discussionmentioning

confidence: 99%

HLA Sensitization in Pediatric Pre-transplant Cardiac Patients Supported by Mechanical Assist Devices: the Utility of Luminex

Yang

Schall

Smith

et al. 2009

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 99%

HLA Sensitization in Pediatric Pre-transplant Cardiac Patients Supported by Mechanical Assist Devices: the Utility of Luminex

Yang

Schall

Smith

et al. 2009

The Journal of Heart and Lung Transplantation

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“…The development of preformed (21) or de novo (23,24) anti‐HLA DSA has been shown to correlate with acute humoral rejection and is a significant risk factor for transplant glomerulopathy (TG) and graft loss. Posttransplant monitoring of DSA is neither a sensitive nor specific test for predicting graft pathology and thus is not a substitute for histopathology.…”

Section: Introductionmentioning

confidence: 85%

Surveillance Protocol Kidney Transplant Biopsies: Their Evolving Role in Clinical Practice

Henderson

Nankivell

Chapman

2011

American Journal of Transplantation

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Protocol renal allograft biopsies at fixed time points from transplantation have aided research and provided insights into the pathogenesis of early and late allograft injury. Their role is evolving from research to a clinical management tool needed to detect subclinical pathology requiring treatment adjustment. They frequently reveal unexpected findings and influence therapy in the majority of patients. Detection of subclinical rejection (SCR) remains important despite declining prevalence with triple therapy, the evidence favors treatment, if found. Surveillance biopsies in steroid avoidance and calcineurin inhibitor (CNI) withdrawal programs provide an important safety net against the increased rates of late acute and SCR. Individualization of therapy in high-risk patients and safe reduction of immunosuppression in standard risk individuals becomes possible. Other potentially reversible chronic pathologies that may be detected, include chronic Tcell or antibody-mediated rejection, recurrent disease, BK virus-associated nephropathy, interstitial fibrosis and tubular atrophy and CNI nephrotoxicity, allowing modifications of therapy to limit ongoing graft injury. Biopsy is safe and inexpensive compared with costs of earlier graft failure and return to dialysis. This review summarizes current evidence on use of surveillance histology for the clinical practice of renal transplantation.

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“…On the other hand, quantitative evaluation of soluble interleukin receptor (sIL‐2R) has also been found to be useful in the detection of rejection in recipients of kidney and heart allografts (5,6). Recent studies have substantiated that immunologic monitoring of antidonor antibodies and cytokines in peripheral blood, serum and urine could be a predictive marker to improve diagnosis and treatment of allograft rejection (7–9). The objective of this study is to analyze the clinical relevance of immune parameters following live‐related renal transplantation by correlating allograft survival with donor‐specific anti‐HLA antibodies, intracellular expression of cytokines and sIL‐2R involved in immune response, which are the major predictors of graft outcome following renal transplantation.…”

mentioning

confidence: 99%

Functional assessment of immune markers of graft rejection: a comprehensive study in live‐related donor renal transplantation

Panigrahi¹,

Deka²,

Bhowmik³

et al. 2005

Clinical Transplantation

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A better understanding of the immunobiological processes and predictors of graft rejection holds promise for the development of potential therapeutic strategies and also individualization of immunosuppression. The objective of this study is to analyze the clinical relevance of immune parameters such as antidonor antihuman leukocyte antigen (anti-HLA) antibodies, monitoring of cytokines and their receptors on the graft outcome following live-related donor renal transplantation. Flow cytometry-based methods were used to detect antidonor antibodies (flow cytometry crossmatch, FCXM) and intracellular cytokines. Enzyme-linked immunosorbent assay (ELISA) methods were employed to detect anti-HLA class I and class II antibodies and quantitative serum-soluble interleukin-2 receptor (sIL-2R) levels. The data revealed that patients with HLA class I-specific IgG antibody experienced higher acute rejection (AR) episodes at 1 yr in comparison to the antibody negative group (82% vs. 56%, p = 0.01). On the contrary, donor-specific class II antibodies (B+) did not have any influence on the graft survival. However, 15 recipients having both T- and B-cell antidonor antibodies (T+B+) had significantly poor graft survival (60%) as compared to the antibody-negative group (T-B-, 82%, p = 0.05). Additionally, patients having non-donor but HLA-specific antibodies (FCXM-/ELISA+) had poor graft survival as compared to the antibody-negative group (64% vs. 88%, p < 0.05). Further, patients undergoing AR episodes had significantly higher expression of IFN-gamma-producing T cells (19.16 +/- 7.4% median 17.50) as compared to their pre-transplant levels (5.68 +/- 1.63%, Median 5.20) and the non-rejecter group (5.97 +/- 4.39%, median 4.3, p = 0.0004). Similarly sIL-2 was significantly increased in AR episodes during the first month of transplantation (292 +/- 131.5 pmol/L) as compared to those with well-functioning grafts (p = 0.01) and healthy controls (p = 0.001). Evaluation of antidonor antibodies by flow cytometry is found to be relatively more sensitive and a better predictor of graft outcome. Further monitoring of cytokine expression profile of primed peripheral T-helper cells and quantitative analysis of sIL-2R offer additional valuable diagnostic and prognostic tools for follow-up of transplant subjects and a better alternative for functional assessment of immunosuppression.

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Immunological monitoring of posttransplant allograft sensitization following living related donor renal transplantation

Cited by 15 publications

References 12 publications

HLA Sensitization in Pediatric Pre-transplant Cardiac Patients Supported by Mechanical Assist Devices: the Utility of Luminex

HLA Sensitization in Pediatric Pre-transplant Cardiac Patients Supported by Mechanical Assist Devices: the Utility of Luminex

Surveillance Protocol Kidney Transplant Biopsies: Their Evolving Role in Clinical Practice

Functional assessment of immune markers of graft rejection: a comprehensive study in live‐related donor renal transplantation

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