51
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Zecher D, Bach C, Staudner C, Böger CA, Bergler T, Banas B, Spriewald BM. Characteristics of donor-specific anti-HLA antibodies and outcome in renal transplant patients treated with a standardized induction regimen. Nephrol Dial Transplant 2017; 32:730-737. [DOI: 10.1093/ndt/gfw445] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 11/28/2016] [Indexed: 11/13/2022] Open
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52
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Størset E, Åsberg A, Hartmann A, Reisaeter AV, Holdaas H, Skauby M, Bergan S, Midtvedt K. Low-target tacrolimus in de novo standard risk renal transplant recipients: A single-centre experience. Nephrology (Carlton) 2016; 21:821-7. [DOI: 10.1111/nep.12738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 01/20/2016] [Accepted: 02/01/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Elisabet Størset
- Department of Transplant Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Anders Åsberg
- Department of Transplant Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
- School of Pharmacy; University of Oslo; Oslo Norway
| | - Anders Hartmann
- Department of Transplant Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
| | - Anna V. Reisaeter
- Department of Transplant Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
| | - Hallvard Holdaas
- Department of Transplant Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
| | - Morten Skauby
- Department of Transplant Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
| | - Stein Bergan
- School of Pharmacy; University of Oslo; Oslo Norway
- Department of Pharmacology; Oslo University Hospital; Oslo Norway
| | - Karsten Midtvedt
- Department of Transplant Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
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53
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Patel SJ, Suki WN, Loucks-DeVos J, Graviss EA, Nguyen DT, Knight RJ, Kuten SA, Moore LW, Teeter LD, Gaber LW, Gaber AO. Disparate rates of acute rejection and donor-specific antibodies among high-immunologic risk renal transplant subgroups receiving antithymocyte globulin induction. Transpl Int 2016; 29:897-908. [PMID: 27196395 DOI: 10.1111/tri.12791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 02/29/2016] [Accepted: 04/27/2016] [Indexed: 01/15/2023]
Abstract
Lymphocyte-depleting induction lowers acute rejection (AR) rates among high-immunologic risk (HIR) renal transplant recipients, including African Americans (AAs), retransplants, and the sensitized. It is unclear whether different HIR subgroups experience similarly low rates of AR. We aimed to describe the incidence of AR and de novo donor-specific antibody (dnDSA) among HIR recipients categorized by age, race, or donor type. All received antithymocyte globulin (ATG) induction and triple maintenance immunosuppression. A total of 464 HIR recipients from 2007 to 2014 were reviewed. AR and dnDSA rates at 1 year for the entire population were 14% and 27%, respectively. AR ranged from 6.7% among living donor (LD) recipients to 30% in younger AA deceased donor (DD) recipients. De novo donor-specific antibody at 1 year ranged from 7% in older non-AA LD recipients to 32% in AAs. AA race remained as an independent risk factor for AR among DD recipients and for dnDSA among all HIR recipients. Development of both AR and dnDSA within the first year was associated with a 54% graft survival at 5 years and was an independent risk factor for graft loss. Despite utilization of recommended immunosuppression for HIR recipients, substantial disparities exist among subgroups, warranting further consideration of individualized immunosuppression in certain HIR subgroups.
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Affiliation(s)
- Samir J Patel
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
| | - Wadi N Suki
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | | | - Edward A Graviss
- Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Duc T Nguyen
- Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Richard J Knight
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Samantha A Kuten
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
| | - Linda W Moore
- Department of Pharmacy, Kansas University Medical Center, Kansas City, KS, USA
| | | | - Lillian W Gaber
- Department of Pathology, Houston Methodist Hospital, Houston, TX, USA
| | - A Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
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Richter R, Süsal C, Köhler S, Qidan S, Schödel A, Holschuh L, Brzoska M, Asbe-Vollkopf A, Büttner S, Betz C, Herrmann E, Gauer S, Seifried E, Geiger H, Seidl C, Hauser IA. Pretransplant human leukocyte antigen antibodies detected by single-antigen bead assay are a risk factor for long-term kidney graft loss even in the absence of donor-specific antibodies. Transpl Int 2016; 29:988-98. [DOI: 10.1111/tri.12786] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 06/18/2015] [Accepted: 04/07/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Rudolf Richter
- Department of Transplantation Immunology; Institute of Transfusion Medicine; German Red Cross; Blood Donation Service Baden-Württemberg-Hessen; Frankfurt Germany
| | - Caner Süsal
- Department of Transplantation Immunology; Institute of Immunology; University of Heidelberg; Heidelberg Germany
| | - Stefanie Köhler
- Department of Transplantation Immunology; Institute of Transfusion Medicine; German Red Cross; Blood Donation Service Baden-Württemberg-Hessen; Frankfurt Germany
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Sara Qidan
- Department of Transplantation Immunology; Institute of Transfusion Medicine; German Red Cross; Blood Donation Service Baden-Württemberg-Hessen; Frankfurt Germany
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Alicia Schödel
- Department of Transplantation Immunology; Institute of Transfusion Medicine; German Red Cross; Blood Donation Service Baden-Württemberg-Hessen; Frankfurt Germany
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Lisa Holschuh
- Department of Transplantation Immunology; Institute of Transfusion Medicine; German Red Cross; Blood Donation Service Baden-Württemberg-Hessen; Frankfurt Germany
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Martin Brzoska
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Aida Asbe-Vollkopf
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Stefan Büttner
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Christoph Betz
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Eva Herrmann
- Institute for Biostatistics and Mathematical Modelling; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Stefan Gauer
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Erhard Seifried
- Department of Transplantation Immunology; Institute of Transfusion Medicine; German Red Cross; Blood Donation Service Baden-Württemberg-Hessen; Frankfurt Germany
| | - Helmut Geiger
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
| | - Christian Seidl
- Department of Transplantation Immunology; Institute of Transfusion Medicine; German Red Cross; Blood Donation Service Baden-Württemberg-Hessen; Frankfurt Germany
| | - Ingeborg A. Hauser
- Department of Nephrology; University Clinic Frankfurt, Goethe-University; Frankfurt Germany
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Carey BS, Boswijk K, Mabrok M, Rowe PA, Connor A, Saif I, Poles A. A reliable method for avoiding false negative results with Luminex single antigen beads; evidence of the prozone effect. Transpl Immunol 2016; 37:23-27. [PMID: 27109036 DOI: 10.1016/j.trim.2016.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/10/2016] [Accepted: 04/15/2016] [Indexed: 11/28/2022]
Abstract
Luminex single antigen bead (SAB) assays have become an essential tool in monitoring the status of antibody to the Human Leucocyte Antigen (HLA) of patients both before and after transplantation. In addition SAB data is used to aid risk stratification to assess immunological risk of humoral rejection in solid organ transplantation (CTAG/BTAG guidelines) [1]. Increasingly laboratories are reporting false negative results at high antibody titre due to a prozone effect. Here we report a case study where the prozone effect led to a false negative antibody result that could have resulted in adverse outcome. We describe a method to reliably remove the prozone effect through heat inactivation and the addition of Ethylenediaminetetraacetic acid (EDTA) to the Luminex wash buffer.
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Affiliation(s)
- B Sean Carey
- H&I, Combined Labs, Derriford Hospital, Plymouth, United Kingdom.
| | - Kim Boswijk
- H&I, Combined Labs, Derriford Hospital, Plymouth, United Kingdom
| | - Mazen Mabrok
- H&I, Combined Labs, Derriford Hospital, Plymouth, United Kingdom
| | - Peter A Rowe
- South West Transplant Centre, Derriford Hospital, Plymouth, United Kingdom
| | - Andrew Connor
- South West Transplant Centre, Derriford Hospital, Plymouth, United Kingdom
| | - Imran Saif
- South West Transplant Centre, Derriford Hospital, Plymouth, United Kingdom
| | - Anthony Poles
- H&I, Combined Labs, Derriford Hospital, Plymouth, United Kingdom; NHS-BT, Filton, United Kingdom
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56
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Rabbit antithymocyte globulin and donor-specific antibodies in kidney transplantation — A review. Transplant Rev (Orlando) 2016; 30:85-91. [DOI: 10.1016/j.trre.2015.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 12/22/2015] [Indexed: 01/28/2023]
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57
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Characteristics of Circulating Donor Human Leukocyte Antigen-specific Immunoglobulin G Antibodies Predictive of Acute Antibody-mediated Rejection and Kidney Allograft Failure. Transplantation 2015; 99:1156-64. [PMID: 25629531 DOI: 10.1097/tp.0000000000000511] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Characteristics of pretransplant antibodies directed at donor human leukocyte antigen (HLA) donor-specific antibodies (DSA) associated with adverse outcomes in kidney transplant recipients are being elucidated but uncertainties exist. METHODS We prospectively screened pretransplant sera from 543 kidney recipients using single antigen bead assays and identified 154 patients with and 389 without DSA. We investigated the association of DSA features to acute rejection and graft failure. RESULTS One-year acute rejection incidence was higher in DSA-positive group (P < 0.001), primarily due to antibody-mediated rejection (AMR, 13% vs. 1.8%, P < 0.001) and not T cell-mediated rejection (ACR, 5% vs.6%, P = 0.65). The sum of mean fluorescence intensity of DSA (DSA MFI-Sum) of 6,000 or higher (OR, 18; 95% CI, 7.0-47; P < 0.001) and the presence of DSA against both HLA class I and II (OR, 39; 95% CI, 14-106; P < 0.0001) predicted 1-year AMR, independent of other covariates. Calculated panel reactive antibody and a positive flow cytometry cross-match result were associated with AMR by bivariate analysis but neither was an independent predictor in a multivariable regression analysis that included DSA-MFI-Sum or HLA DSA class. In multivariable Cox proportional hazards models, the covariate-adjusted hazard ratio for graft failure was 2.03 (95%CI, 1.05-3.92; P = 0.04) for DSA MFI-Sum of 6,000 or higher and 2.23 (95% CI, 1.04-4.80; P = 0.04) for class I and II DSA. Prediction of graft failure was not independent of AMR. CONCLUSION Our study suggests that DSA MFI-Sum and HLA class of DSA are characteristics predictive of AMR and graft failure. The elevated risk of graft failure in those with the identified features of DSA is attributable to increased risk of AMR.
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58
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Melilli E, Crespo E, Sandoval D, Manonelles A, Sala N, Mast R, Padulles A, Grinyo JM, Bestard O, Cruzado JM. De novouse of a generic formulation of tacrolimus versus reference tacrolimus in kidney transplantation: evaluation of the clinical results, histology in protocol biopsies, and immunological monitoring. Transpl Int 2015; 28:1283-90. [DOI: 10.1111/tri.12626] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/06/2015] [Accepted: 06/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Edoardo Melilli
- Bellvitge University Hospital; Department of Nephrology; Renal Transplantation Unit carrer de la feixa llarga L'Hospitalet de Llobregat; Barcelona Spain
| | - Elena Crespo
- IDIBELL; Department of Experimental Nephrology; Carrer de la feixa llarga L'Hospitalet de Llobregat; Barcelona Spain
| | - Diego Sandoval
- Bellvitge University Hospital; Department of Nephrology; Renal Transplantation Unit carrer de la feixa llarga L'Hospitalet de Llobregat; Barcelona Spain
| | - Anna Manonelles
- Bellvitge University Hospital; Department of Nephrology; Renal Transplantation Unit carrer de la feixa llarga L'Hospitalet de Llobregat; Barcelona Spain
- IDIBELL; Department of Experimental Nephrology; Carrer de la feixa llarga L'Hospitalet de Llobregat; Barcelona Spain
| | - Neus Sala
- Bellvitge University Hospital; Department of Nephrology; Renal Transplantation Unit carrer de la feixa llarga L'Hospitalet de Llobregat; Barcelona Spain
| | - Richard Mast
- Department of Radiology; Bellvitge University Hospital; Carrer de la feixa llarga L'Hospitalet de Llobregat; Barcelona Spain
| | - Ariadna Padulles
- Department of Pharmacy; Bellvitge University Hospital; Carrer de la feixa llarga L'Hospitalet de Llobregat; Barcelona Spain
| | - Josep M. Grinyo
- Bellvitge University Hospital; Department of Nephrology; Renal Transplantation Unit carrer de la feixa llarga L'Hospitalet de Llobregat; Barcelona Spain
| | - Oriol Bestard
- Bellvitge University Hospital; Department of Nephrology; Renal Transplantation Unit carrer de la feixa llarga L'Hospitalet de Llobregat; Barcelona Spain
- IDIBELL; Department of Experimental Nephrology; Carrer de la feixa llarga L'Hospitalet de Llobregat; Barcelona Spain
| | - Josep Maria Cruzado
- Bellvitge University Hospital; Department of Nephrology; Renal Transplantation Unit carrer de la feixa llarga L'Hospitalet de Llobregat; Barcelona Spain
- IDIBELL; Department of Experimental Nephrology; Carrer de la feixa llarga L'Hospitalet de Llobregat; Barcelona Spain
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59
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Filippone EJ, Farber JL. Humoral Immune Response and Allograft Function in Kidney Transplantation. Am J Kidney Dis 2015; 66:337-47. [PMID: 25987262 DOI: 10.1053/j.ajkd.2015.03.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 03/22/2015] [Indexed: 12/22/2022]
Abstract
HLA antibodies can damage a kidney transplant. In January 2013, consensus guidelines from The Transplantation Society were published regarding technical aspects of HLA antibody determination, as well as their potential significance in the pre- and posttransplantation periods. During the past 2 years, new studies have been reported, but controversies remain. In this article, these new data related to HLA antibodies in kidney transplantation are reviewed and compared to relevant prior research. Pretransplantation sensitization issues are discussed, including the new more sensitive assays (flow cytometry and solid-phase immunoassays such as Luminex single-antigen bead assays). A positive complement-dependent cytotoxicity crossmatch remains an absolute contraindication to transplantation, although a positive flow cytometry crossmatch is only a relative contraindication. Positivity only by solid-phase assays increases the risk for acute rejection and transplant loss, but acceptable cutoffs are not defined. The sensitizing effect of red blood cell transfusions is substantiated. Following allograft failure, continued immunosuppression decreases the risk of sensitization, whereas overall, the effect of nephrectomy remains uncertain. Regarding the posttransplantation period, new data are available concerning the timing and significance of donor-specific antibodies (DSA). Whereas some centers report DSA appearance after years, others detect DSA within months. The prominence of class II DSA, especially DQ, in the posttransplantation period is noted. The relevance of non-HLA antibodies is discussed, including anti-endothelial cell antibodies, major histocompatibility complex class I chain-related protein A antibodies, and angiotensin II type 1 receptor autoantibodies.
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Affiliation(s)
- Edward J Filippone
- Division of Nephrology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.
| | - John L Farber
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA
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Pouliquen E, Koenig A, Chen CC, Sicard A, Rabeyrin M, Morelon E, Dubois V, Thaunat O. Recent advances in renal transplantation: antibody-mediated rejection takes center stage. F1000PRIME REPORTS 2015; 7:51. [PMID: 26097724 PMCID: PMC4447042 DOI: 10.12703/p7-51] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Overlooked for decades, antibodies have taken center stage in renal transplantation and are now widely recognized as the first cause of allograft failure. Diagnosis of antibody-mediated rejection has considerably improved with identification of antibody-mediated lesions in graft biopsies and advances made in the detection of circulating donor-specific antibodies. Unfortunately, this progress has not yet translated into better outcomes for patients. Indeed, in the absence of a drug able to suppress antibody generation by plasma cells, available therapies can only slow down graft destruction. This review provides an overview of the current knowledge of antibody-mediated rejection and discusses future interesting research directions.
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Affiliation(s)
- Eric Pouliquen
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
| | - Alice Koenig
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
| | - Chien Chia Chen
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
| | - Antoine Sicard
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
| | - Maud Rabeyrin
- Laboratoire d‘anatomopathologie, Hospices Civils de Lyon, Hôpital Edouard HerriotLyonFrance
| | - Emmanuel Morelon
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
| | - Valérie Dubois
- Laboratoire d‘Histocompatibilité, Etablissement Français du SangLyonFrance
| | - Olivier Thaunat
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
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Shabir S, Girdlestone J, Briggs D, Kaul B, Smith H, Daga S, Chand S, Jham S, Navarrete C, Harper L, Ball S, Borrows R. Transitional B lymphocytes are associated with protection from kidney allograft rejection: a prospective study. Am J Transplant 2015; 15:1384-91. [PMID: 25808898 DOI: 10.1111/ajt.13122] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 01/25/2023]
Abstract
Recent cross-sectional studies suggest an important role for transitional B lymphocytes (CD19 + CD24hiCD38hi) in promoting transplant tolerance, and protecting from late antibody-mediated rejection (ABMR). However, prospective studies are lacking. This study enrolled 73 de novo transplant recipients, and collected serial clinical, immunological and biochemical information over 48 ± 6 months. Cell phenotyping was conducted immediately prior to transplantation, and then on five occasions during the first year posttransplantation. When modeled as a time-dependent covariate, transitional B cell frequencies (but not total B cells or "regulatory" T cells) were associated with protection from acute rejection (any Banff grade; HR: 0.60; 95% CI: 0.37-0.95; p = 0.03). No association between transitional B cell proportions and either de novo donor-specific or nondonor-specific antibody (dnDSA; dnNDSA) formation was evident, although preserved transitional B cell proportions were associated with reduced rejection rates in those patients developing dnDSA. Three episodes of ABMR occurred, all in the context of nonadherence, and all associated with in vitro anti-HLA T cell responses in an ELISPOT assay (p = 0.008 versus antibody-positive patients not experiencing ABMR). This prospective study supports the potential relevance of transitional ("regulatory") B cells as a biomarker and therapeutic intervention in transplantation, and highlights relationships between humoral immunity, cellular immunity and nonadherence.
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Affiliation(s)
- S Shabir
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, UK; Centre for Translational Inflammation Research, University of Birmingham, UK
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Remport A, Ivanyi B, Mathe Z, Tinckam K, Mucsi I, Molnar MZ. Better understanding of transplant glomerulopathy secondary to chronic antibody-mediated rejection. Nephrol Dial Transplant 2014; 30:1825-33. [PMID: 25473123 DOI: 10.1093/ndt/gfu371] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 11/03/2014] [Indexed: 01/08/2023] Open
Abstract
Transplant glomerulopathy (TG) is generally accepted to result from repeated episodes of endothelial activation, injury and repair, leading to pathological abnormalities of double contouring or multi-layering of the glomerular basement membrane. TG is a major sequel of chronic active antibody-mediated rejection (cABMR), from pre-existing or de novo anti-HLA antibodies. Hepatitis C infection, thrombotic microangiopathy or other factors may also contribute to TG development. TG prevalence is 5-20% in most series, reaching 55%, in some high-risk cohorts, and is associated with worse allograft outcomes. Despite its prevalence and clinical significance, few well-studied treatment options have been proposed. Similar to desensitization protocols, plasmapheresis with or without immunoabsorption, high-dose intravenous immunoglobulin, rituximab, bortezomib and eculizumab have been proposed in the treatment of TG due to cABMR individually or in various combinations. Robust clinical trials are urgently needed to address this major cause of allograft loss. This review summarizes the current knowledge of the epidemiology, etiology, pathology, and the preventive and treatment options for TG secondary to cABMR.
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Affiliation(s)
- Adam Remport
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Bela Ivanyi
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Zoltan Mathe
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Kathryn Tinckam
- Division of Nephrology, Department of Medicine,University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Istvan Mucsi
- Division of Nephrology, Department of Medicine,University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Miklos Z Molnar
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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