Impact of Donor-Specific Antibodies on Chronic Rejection Occurrence and Graft Loss in Renal Transplantation: Posttransplant Analysis Using Flow Cytometric Techniques1

Piazza, A.; Poggi, E.; Borrelli, Laura A.; Servetti, S; Monaco, P. I.; Buonomo, Oreste Claudio; Valeri, M; Torlone, N.; Adorno, D.; Casciani, Carlo Umberto

doi:10.1097/00007890-200104270-00017

Cited by 130 publications

(91 citation statements)

References 19 publications

(18 reference statements)

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“…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]. Especially high HLA class II antibody levels are related to an increased risk of developing transplant glomerulopathy and C4d deposits in peritubular capillaries [43].…”

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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Section: Detection Of Hla Antibodiesmentioning

confidence: 99%

Acute and chronic antibody-mediated rejection in pediatric kidney transplantation

et al. 2014

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“…However, only 4.4% of patients had de novo DS anti-HLA antibodies. A similar study (15) prospectively screened 120 unsensitized kidney transplant recipients for DS anti-HLA antibodies at 1 yr after transplantation by FC crossmatch and FlowPRA. Overall, 24.2% had developed DS anti-HLA antibodies, and most of them were detected within the first 3 mo after transplantation.…”

Section: Incidence and Allograft Outcomementioning

confidence: 99%

Sensitization after Kidney Transplantation

Akalin¹,

Pascual²

2006

Clinical Journal of the American Society of Nephrology

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Kidney transplant recipients may develop de novo anti-HLA and non-HLA antibodies after transplantation. Although these antibodies may be donor-specific or non-donor-specific, their presence may increase the risk for acute and chronic rejection, thereby decreasing allograft survival. The introduction of more sensitive and specific methods to detect anti-HLA antibodies, such as Flow Specific Beads and FlowPRA, both before and after transplantation, will help to define immunologically high-risk kidney transplant recipients. Thus, posttransplantation monitoring of anti-HLA antibody production will allow the identification of kidney transplant recipients who might be at increased risk for late allograft failure. Moreover, knowledge of alloantibody status after transplantation may help to guide the appropriate use of immunomodulatory agents to downregulate anti-HLA antibody production.

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“…Antibodies against donor HLA, termed donor-specific alloantibodies (DSA), pose a significant barrier to successful kidney transplantation because of the increased risk of both early and late graft loss (1,2). However, since many candidates have antibodies which react against a broad range of HLA, finding a donor against whom they have no antibody can be difficult.…”

Section: Introductionmentioning

confidence: 99%

Five-Year Outcomes in Living Donor Kidney Transplants With a Positive Crossmatch

Bentall

Cornell

Gloor

et al. 2013

American Journal of Transplantation

184

141

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Renal transplant candidates with high levels of donorspecific anti-HLA antibodies have low transplantation rates and high mortality rates on dialysis. Using desensitization protocols, good short-term outcomes are possible in "positive crossmatch kidney transplants (+XMKTx)" , but long-term outcome data are lacking. The aim of the current study was to determine actual 5-year graft outcomes of +XMKTx. We compared graft survival and the functional and histologic status of 102 +XMKTx to 204 −XMKTx matched for age and sex. Actual 5-year death-censored graft survival was lower in the +XMKTx group (70.7% vs. 88.0%, p < 0.01) and chronic injury (glomerulopathy) was present in 54.5% of surviving grafts. Graft survival was higher in recipients with antibody against donor class I only compared with antibody against class II (either alone or in combination with class I) (85.3% vs. 62.6%, p = 0.05) and was similar to −XMKTx (85.3 vs. 88.0%, p = 0.64). Renal function and proteinuria ranged across a wide spectrum in all groups reflecting the different histological findings at 5 years. We conclude that when compared to −XMKTx, +XMKTx have inferior outcomes at 5 years, however, almost half of the surviving grafts do not have glomerulopathy and avoiding antibodies against donor class II may improve outcomes.

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Impact of Donor-Specific Antibodies on Chronic Rejection Occurrence and Graft Loss in Renal Transplantation: Posttransplant Analysis Using Flow Cytometric Techniques1

Cited by 130 publications

References 19 publications

Acute and chronic antibody-mediated rejection in pediatric kidney transplantation

Acute and chronic antibody-mediated rejection in pediatric kidney transplantation

Sensitization after Kidney Transplantation

Five-Year Outcomes in Living Donor Kidney Transplants With a Positive Crossmatch

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