Sensitization after Kidney Transplantation

Akalin, Enver; Pascual, Manuel

doi:10.2215/cjn.01751105

Cited by 59 publications

(49 citation statements)

References 63 publications

(52 reference statements)

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“…These findings suggest that all patients with strong DSA, whether class I or II, may need PP to decrease the load of circulating alloantibodies and the incidence of acute AMR. Previous studies, summarized in a recent review article (16), showed that both class I and II DSA can be associated with acute and chronic rejection. The acute rejection rate has been Ͼ30% in patients who receive desensitization protocols, and it is still not clear which protocol (high-dosage IVIG, PP/low-dosage IVIG), what type of induction treatment (Thymoglobulin, anti-IL-2R antibodies, alemtuzumab), or addition of rituximab is better for the prevention of early acute AMR.…”

Section: Discussionmentioning

confidence: 99%

Addition of Plasmapheresis Decreases the Incidence of Acute Antibody-Mediated Rejection in Sensitized Patients with Strong Donor-Specific Antibodies

Akalin

Dinavahi

Friedlander

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: The objective of this study was to investigate the effects of desensitization protocols using intravenous Ig with or without plasmapheresis in patients with donor-specific anti-HLA antibodies on prevention of antibody-mediated rejection and downregulation of donor-specific antibodies.Design, setting, participants, & measurements: Thirty-five complement-dependent cytotoxicity T cell cross-match-negative but complement-dependent cytotoxicity B cell and/or flow cytometry cross-match-positive kidney transplant recipients were treated with high-dosage intravenous Ig plus Thymoglobulin induction treatment. Donor-specific antibody strength was stratified as strong, medium, or weak by Luminex flow beads. Group 1 patients had weak/moderate and group 2 strong donor-specific antibodies Results: Whereas no group 1 patients had acute rejection, 66% of group 2 had acute rejection (44% antibody-mediated rejection, 22% cellular rejection). The protocol was then changed to the addition of peritransplantation plasmapheresis to patients with strong donor-specific antibodies (group 3). This change resulted in a dramatic decrease in the acute rejection rate to 7%. During a median 18 mo of follow-up, patient survival was 100, 100, and 93% and graft survival was 100, 78, and 86% in groups 1, 2, and 3, respectively. During follow-up, 17 (52%) patients lost donor-specific antibodies completely, and 10 (30%) lost some of donor-specific antibodies and/or decreased the strength of existing donor-specific antibodies.Conclusions: These results indicated that in patients with strong donor-specific antibodies, the addition of plasmapheresis to high-dosage intravenous Ig decreases the incidence of acute rejection. The majority of the patients, whether they received intravenous Ig alone or with plasmapheresis, lost their donor-specific antibodies during follow-up.

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Section: Discussionmentioning

confidence: 99%

Addition of Plasmapheresis Decreases the Incidence of Acute Antibody-Mediated Rejection in Sensitized Patients with Strong Donor-Specific Antibodies

Akalin

Dinavahi

Friedlander

et al. 2008

Clinical Journal of the American Society of Nephrology

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“…HLA antibodies can be present before transplantation, because of prior exposure to nonself HLA molecules (after pregnancy, blood transfusion or prior allo-transplantation), or can be produced de novo after transplantation (5). Donor-specific anti-HLA alloantibodies can initiate rejection through complement-mediated and antibody-dependent, cell-mediated cytotoxicity (6,7).…”

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confidence: 99%

Identifying compartment-specific non-HLA targets after renal transplantation by integrating transcriptome and “antibodyome” measures

Li¹,

Wadia²,

Chen

et al. 2009

Proc. Natl. Acad. Sci. U.S.A.

141

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We have conducted an integrative genomics analysis of serological responses to non-HLA targets after renal transplantation, with the aim of identifying the tissue specificity and types of immunogenic non-HLA antigenic targets after transplantation. Posttransplant antibody responses were measured by paired comparative analysis of pretransplant and posttransplant serum samples from 18 pediatric renal transplant recipients, measured against 5,056 unique protein targets on the ProtoArray platform. The specificity of antibody responses were measured against gene expression levels specific to the kidney, and 2 other randomly selected organs (heart and pancreas), by integrated genomics, employing the mapping of transcription and ProtoArray platform measures, using AILUN. The likelihood of posttransplant non-HLA targets being recognized preferentially in any of 7 microdissected kidney compartments was also examined. In addition to HLA targets, non-HLA immune responses, including anti-MICA antibodies, were detected against kidney compartment-specific antigens, with highest posttransplant recognition for renal pelvis and cortex specific antigens. The compartment specificity of selected antibodies was confirmed by IHC. In conclusion, this study provides an immunogenic and anatomic roadmap of the most likely non-HLA antigens that can generate serological responses after renal transplantation. Correlation of the most significant non-HLA antibody responses with transplant health and dysfunction are currently underway.integrative genomics ͉ kidney compartment ͉ kidney transplantation ͉ non-HLA antigen

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“…Aunque algún estudio muestra asociación entre la reexposición a antígenos HLA no compatibles y menor supervivencia del injerto 16 , la mayoría de las series no aprecian diferencias en el número de incompatibilidades entre los diversos trasplantes 18,20,23 . En nuestro estudio la media de anticuerpos anti-HLA previo al segundo trasplante fue del 17%, aumentando significativamente respecto al primero 24,25 . Aunque clásicamente el incremento del porcentaje de anticuerpos anti-HLA previo a cada trasplante se asocia con una disminución de la supervivencia de los sucesivos trasplantes 26,27 , en nuestra experiencia el incremento en el porcentaje de anticuerpos anti-HLA no influye en la supervivencia del segundo injerto.…”

Section: Discussionunclassified

Retrasplante renal: factores de riesgo y resultados

Arce¹,

Rosales²,

Caffaratti³

et al. 2011

Actas Urológicas Españolas

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PALABRAS CLAVE Retrasplante; Factores de riesgo; Supervivencia injertoResumen Objetivo: revisar nuestra experiencia en retrasplantes renales. Material y métodos: se realizó un estudio retrospectivo de 71 pacientes retrasplantados entre 1980 y 2005. Se analizaron: características del receptor e injerto, datos de la intervención, causas de pérdida del injerto, número de rechazos y trasplantectomías y supervivencia del injerto. Resultados: la causa más frecuente de pérdida del injerto fue el rechazo crónico. Las causas de pérdida del primer injerto no se asociaron con una mayor pérdida del segundo (p > 0,05). El porcentaje de anticuerpos anti-HLA incrementó en el segundo trasplante respecto del primero (17,23 ± 27,91% vs 1,21 ± 7,43%) (p = 0,001), pero no se correlacionó con un aumento significativo de pérdida del segundo injerto (p = 0,320). No existieron diferencias significativas entre las complicaciones del primer y segundo trasplante (p > 0,05) y no se asociaron con una pérdida del injerto (p > 0,05). Los pacientes con una trasplantectomía en el primer trasplante presentaban un riesgo 8,5 veces mayor de sufrir una segunda (p = 0,0001; OR: 8,54; IC 95%: 0,941 -77,501). La causa más frecuente de trasplantectomía en el segundo trasplante fue el rechazo agudo. El rechazo agudo como causa de trasplantectomía en el primer trasplante se mostró como factor de riesgo independiente de trasplantectomía del segundo trasplante (p = 0,009). La supervivencia media del segundo injerto fue de 5,08 ± 4,81 años, superior al primer trasplante (p = 0,133). La supervivencia del injerto a 1, 5 y 10 años fue del 83, 75 y 52%, respectivamente. Conclusiones: la supervivencia del segundo trasplante no es inferior al primero y tampoco existe incremento en el número de complicaciones. © 2010 AEU. Publicado por Elsevier España, S.L. Todos los derechos reservados. KEYWORDSRetransplantation; Risk factors; Graft survival Renal retransplantation: risk factors and results AbstractObjective: to review our experience in renal retransplantations. Materials and methods: we carried out a retrospective study on 71 patients with retransplantation performed between 1980 and 2005. We studied: the characteristics of the * Autor para correspondencia.

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Sensitization after Kidney Transplantation

Cited by 59 publications

References 63 publications

Addition of Plasmapheresis Decreases the Incidence of Acute Antibody-Mediated Rejection in Sensitized Patients with Strong Donor-Specific Antibodies

Addition of Plasmapheresis Decreases the Incidence of Acute Antibody-Mediated Rejection in Sensitized Patients with Strong Donor-Specific Antibodies

Identifying compartment-specific non-HLA targets after renal transplantation by integrating transcriptome and “antibodyome” measures

Retrasplante renal: factores de riesgo y resultados

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