Risk factors of sensitization to human leukocyte antigen in end-stage renal disease patients

Hung, Shih-Yuan; Lin, Tzu-Chao; Chang, Min-Yu; Wang, Hsi-Hao; Lee, Yi‐Che; Ho, Li-Chun; Chen, Yi-Ting; Hung, C J.; Liou, Hung-Hsiang

doi:10.1016/j.humimm.2014.02.024

Cited by 26 publications

(25 citation statements)

References 21 publications

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“…With particular regard to the latter, subgroup analysis did not show any effect of the lack of immunosuppression induction on the development of DSAs, confirming previous reports . We performed a multivariable logistic regression analysis including the classical risk factors for DSA production (HLA mismatch, previous rejection, allograft nephrectomy) and allosensitization in transplant and end stage renal disease patients (pregnancy and blood transfusions) . We also included the transplant duration in the present model given the significant difference between the NX+ and NX− cohorts.…”

Section: Resultssupporting

confidence: 82%

Allosensitization after transplant failure: the role of graft nephrectomy and immunosuppression – a retrospective study

et al. 2019

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There are conflicting data about the role of transplant nephrectomy and immunosuppression withdrawal on the development of allosensitization and the impact on re-transplantation. We divided 109 first graft recipients into two groups according to whether they underwent nephrectomy (NX+, n = 61) or their graft was left in situ (NXÀ, n = 48). Sera were assessed for HLA-A/B/Cw/DR/DQ antibodies at the time of NX/transplant failure and after 3, 6, 12, 24 months. The NX+ group showed a higher rate of donor specific antibody (DSA) and non-DSA human leukocyte antigen (HLA) antibody production at all the time points. Multivariable analysis showed that nephrectomy was a strong, independent risk factor for the development of DSAs after 12 and 24 months (P = 0.005 and 0.008). In the NXÀ group, low tacrolimus levels correlated with DSA formation (AUC 0.817, P = 0.002; best cut-off level 2.9 ng/ml). Analysis with a standardized pool of UK donors showed a more difficult grade of HLA matchability following nephrectomy compared with the NXÀ group. Nephrectomy is followed by the long-term production of DSA and non-DSA HLA antibodies and negatively impacts on the chances of finding a HLA-compatible kidney. Tacrolimus levels ≥3 ng/ml are protective against the development of allosensitization and could facilitate re-transplantation in the NXÀ group. Transplant International 2019; 32: 949-959

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Section: Resultssupporting

confidence: 82%

Allosensitization after transplant failure: the role of graft nephrectomy and immunosuppression – a retrospective study

et al. 2019

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“…Allosensitization affects approximately 6–9% of cardiac transplant candidates [19, 20] and 23% of renal transplant candidates prior to transplantation [21]. Patients who are presensitized have a significantly increased risk of developing AMR within the first three years after cardiac transplantation compared to those who are not sensitized [22].…”

Section: Hla Antibodiesmentioning

confidence: 99%

Not All Antibodies Are Created Equal: Factors That Influence Antibody Mediated Rejection

Butler

Valenzuela

Thomas

et al. 2017

Journal of Immunology Research

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Consistent with Dr. Paul Terasaki's “humoral theory of rejection” numerous studies have shown that HLA antibodies can cause acute and chronic antibody mediated rejection (AMR) and decreased graft survival. New evidence also supports a role for antibodies to non-HLA antigens in AMR and allograft injury. Despite the remarkable efforts by leaders in the field who pioneered single antigen bead technology for detection of donor specific antibodies, a considerable amount of work is still needed to better define the antibody attributes that are associated with AMR pathology. This review highlights what is currently known about the clinical context of pre and posttransplant antibodies, antibody characteristics that influence AMR, and the paths after donor specific antibody production (no rejection, subclinical rejection, and clinical dysfunction with AMR).

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“…The clinical relevance of presensitization related to the exposure to inert biomaterials should probably not be overestimated, but interventions to support the device, such as blood transfusions for replacement after device-associated hemolysis or adverse events, may contribute significantly to the development of anti-HLA antibodies [110]. Additionally there is controversial evidence concerning dialysis being a risk factor for HLA sensitization: Some reports found hemodialysis to increase the anti-HLA antibody level in a single treatment session [111,112], while others did not find any difference in the anti-HLA antibody levels of end stage renal disease patients before and after dialysis [113]. Still, literature provides no information if temporary dialysis is a potential trigger of de novo synthesis of HLA antibodies in patients with acute renal failure as a complication of major burn trauma.…”

Section: Assist Devicesmentioning

confidence: 99%

Sensitization and desensitization of burn patients as potential candidates for vascularized composite allotransplantation

Klein

Schanz

Hivelin

et al. 2016

Burns

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Sensitization describes the acquired ability of the immune system to react to foreign human leukocyte antigens (HLA) by producing antibodies and developing memory cells. In the field of transplantation, recipient preformed HLA antibodies due to previous sensitization have been identified - beneath ABO incompatibility - as a major factor for acute graft rejection. Several reasons for sensitization have largely been studied, such as previous blood transfusions, pregnancies or former transplants. Recent studies indicate that the use of assist devices (e.g. ECMO) or cadaveric skin allotransplantation providing temporary coverage in burn patients may lead to additional sensitization. As vascularized composite allotransplantation (VCA) has become a rapidly advancing therapeutic option for reconstruction of complex tissue defects in burns, it seems even more important to become familiar with immunological principles and to be cautiously aware of both sources of sensitization and therapeutic concepts in burns avoiding sensitization. This may also include emergency VCAs in burn patients as potential strategy for early definitive reconstruction avoiding procedures triggering HLA antibody formation. We hereby provide an overview on current evidence in the field of pre- and peritransplant sensitization, followed by posttransplant strategies of desensitization and their potential impact on future treatments of burn patients.

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Risk factors of sensitization to human leukocyte antigen in end-stage renal disease patients

Cited by 26 publications

References 21 publications

Allosensitization after transplant failure: the role of graft nephrectomy and immunosuppression – a retrospective study

Allosensitization after transplant failure: the role of graft nephrectomy and immunosuppression – a retrospective study

Not All Antibodies Are Created Equal: Factors That Influence Antibody Mediated Rejection

Sensitization and desensitization of burn patients as potential candidates for vascularized composite allotransplantation

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