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Chauhan R, Tiwari AK, Aggarwal G, Gowri Suresh L, Kumar M, Bansal SB. Low-MFI (median fluorescence intensity) pre-transplant DSA (donor specific antibodies) leading to anamnestic antibody mediated rejection in live-related donor kidney transplantation. Transpl Immunol 2023; 81:101931. [PMID: 37730185 DOI: 10.1016/j.trim.2023.101931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/11/2023] [Accepted: 09/16/2023] [Indexed: 09/22/2023]
Abstract
"In solid organ transplantation, the compatibility between recipient and donor relies on testing prior to transplantation as a major determinant for the successful transplant outcomes. This compatibility testing depends on the detection of donor-specific antibodies (DSAs) present in the recipient. Indeed, sensitized transplant candidates are at higher risk of allograft rejection and graft loss compared to non-sensitized individuals. Most of the laboratories in India have adopted test algorithms for the appropriate risk stratification of transplants, namely: 1) donor cell-based flow-cytometric cross-match (FCXM) assay with patient's serum to detect DSAs; 2) HLA-coated beads to detect anti-HLA antibodies; and 3) complement-dependent cytotoxicity crossmatch (CDCXM) with donor cells to detect cytotoxic antibodies. In the risk stratification strategy, laboratories generally accept a DSA median fluorescence index (MFI) of 1000 MFI or lower MFI (low-MFI) as a negative value and clear the patient for the transplant. We present two cases of live-related donor kidney transplants (LDKTs) with low-MFI pre-transplant DSA values who experienced an early acute antibody-mediated rejection (ABMR) as a result of an anamnestic antibody response by DSA against HLA class II antibodies. These results were confirmed by retesting of both pre-transplant and post-transplant archived sera from patients and freshly obtained donor cells. Our examples indicate a possible ABMR in patients with low MFI pre-transplant DSA. Reclassification of low vs. high-risk may be appropriate for sensitized patients with low-MFI DSA."
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Affiliation(s)
- Rajni Chauhan
- Molecular and Transplant Immunology Laboratory, Department of Transfusion Medicine, Medanta-Gurugram, India
| | - Aseem Kumar Tiwari
- Molecular and Transplant Immunology Laboratory, Department of Transfusion Medicine, Medanta-Gurugram, India.
| | - Geet Aggarwal
- Molecular and Transplant Immunology Laboratory, Department of Transfusion Medicine, Medanta-Gurugram, India
| | - L Gowri Suresh
- Molecular and Transplant Immunology Laboratory, Department of Transfusion Medicine, Medanta-Gurugram, India
| | - Mohit Kumar
- Molecular and Transplant Immunology Laboratory, Department of Transfusion Medicine, Medanta-Gurugram, India
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Süsal C, Slavcev A, Pham L, Zeier M, Morath C. The possible critical role of T-cell help in DSA-mediated graft loss. Transpl Int 2018; 31:577-584. [DOI: 10.1111/tri.13126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/14/2017] [Accepted: 01/29/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Caner Süsal
- Institute of Immunology; University of Heidelberg; Heidelberg Germany
| | - Antonij Slavcev
- Department of Immunogenetics; Institute for Clinical and Experimental Medicine (IKEM); Prague Czech Republic
| | - Lien Pham
- Institute of Immunology; University of Heidelberg; Heidelberg Germany
| | - Martin Zeier
- Division of Nephrology; University of Heidelberg; Heidelberg Germany
| | - Christian Morath
- Division of Nephrology; University of Heidelberg; Heidelberg Germany
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Trailin AV, Ostapenko TI, Nykonenko TN, Nesterenko SN, Nykonenko OS. Peritransplant Soluble CD30 as a Risk Factor for Slow Kidney Allograft Function, Early Acute Rejection, Worse Long-Term Allograft Function, and Patients' Survival. DISEASE MARKERS 2017; 2017:9264904. [PMID: 28694560 PMCID: PMC5485490 DOI: 10.1155/2017/9264904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/27/2017] [Accepted: 04/11/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND We aimed to determine whether serum soluble CD30 (sCD30) could identify recipients at high risk for unfavorable early and late kidney transplant outcomes. METHODS Serum sCD30 was measured on the day of kidney transplantation and on the 4th day posttransplant. We assessed the value of these measurements in predicting delayed graft function, slow graft function (SGF), acute rejection (AR), pyelonephritis, decline of allograft function after 6 months, and graft and patient survival during 5 years of follow-up in 45 recipients. RESULTS We found the association between low pretransplant serum levels of sCD30 and SGF. The absence of significant decrease of sCD30 on the 4th day posttransplant was characteristic for SGF, early AR (the 8th day-6 months), late AR (>6 months), and early pyelonephritis (the 8th day-2 months). Lower pretransplant and posttransplant sCD30 predicted worse allograft function at 6 months and 2 years, respectively. Higher pretransplant sCD30 was associated with higher frequency of early AR, and worse patients' survival, but only in the recipients of deceased-donor graft. Pretransplant sCD30 also allowed to differentiate patients with early pyelonephritis and early AR. CONCLUSIONS Peritransplant sCD30 is useful in identifying patients at risk for unfavorable early and late transplant outcomes.
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Affiliation(s)
- Andriy V. Trailin
- Department of Laboratory Diagnostics and General Pathology, State Institution “Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine”, 20 Winter Boulevard, Zaporizhzhia 69096, Ukraine
| | - Tetyana I. Ostapenko
- Department of Transplantology, Endocrine Surgery and Cardiovascular Surgery, State Institution “Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine”, Zaporizhzhia Regional Hospital, 10 Orikhiv Highway, Zaporizhzhia 69050, Ukraine
| | - Tamara N. Nykonenko
- Institute of Cardiovascular Surgery and Transplantology, State Institution “Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine”, 20 Winter Boulevard, Zaporizhzhia 69096, Ukraine
| | - Svitlana N. Nesterenko
- Immunological Laboratory, Zaporizhzhia Regional Hospital, State Institution “Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine”, 10 Orikhiv Highway, Zaporizhzhia 69050, Ukraine
| | - Olexandr S. Nykonenko
- Department of Transplantology, Endocrine Surgery and Cardiovascular Surgery, State Institution “Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine”, Zaporizhzhia Regional Hospital, 10 Orikhiv Highway, Zaporizhzhia 69050, Ukraine
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High soluble CD30 levels and associated anti-HLA antibodies in patients with failed renal allografts. Int J Artif Organs 2016; 39:547-552. [PMID: 28058698 DOI: 10.5301/ijao.5000537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Serum soluble CD30 (sCD30), a 120-kD glycoprotein that belongs to the tumor necrosis factor receptor family, has been suggested as a marker of rejection in kidney transplant patients. The aim of this study was to evaluate the relationship between sCD30 levels and anti-HLA antibodies, and to compare sCD30 levels in patients undergoing hemodialysis (HD) with and without failed renal allografts and transplant recipients with functioning grafts. METHODS 100 patients undergoing HD with failed grafts (group 1), 100 patients undergoing HD who had never undergone transplantation (group 2), and 100 kidney transplant recipients (group 3) were included in this study. Associations of serum sCD30 levels and anti-HLA antibody status were analyzed in these groups. RESULTS The sCD30 levels of group 1 and group 2 (154 ± 71 U/mL and 103 ± 55 U/mL, respectively) were significantly higher than those of the transplant recipients (group 3) (39 ± 21 U/mL) (p<0.001 and p<0.001). The serum sCD30 levels in group 1 (154 ± 71 U/mL) were also significantly higher than group 2 (103 ± 55 U/mL) (p<0.001). Anti-HLA antibodies were detected in 81 (81%) and 5 (5%) of patients in groups 1 and 2, respectively (p<0.001). When multiple regression analysis was performed to predict sCD30 levels, the independent variables in group 1 were the presence of class I anti-HLA antibodies (β = 0.295; p = 0.003) and age (β = -0.272; p = 0.005), and serum creatinine (β = 0.218; p = 0.027) and presence of class II anti-HLA antibodies (standardized β = 0.194; p = 0.046) in group 3. CONCLUSIONS Higher sCD30 levels and anti-HLA antibodies in patients undergoing HD with failed renal allografts may be related to higher inflammatory status in these patients.
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Donor-specific antibodies require preactivated immune system to harm renal transplant. EBioMedicine 2016; 9:366-371. [PMID: 27333031 PMCID: PMC4972543 DOI: 10.1016/j.ebiom.2016.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/10/2016] [Accepted: 06/03/2016] [Indexed: 01/24/2023] Open
Abstract
Pretransplant DSA have a deleterious impact on graft survival only in the presence of high pretransplant serum levels of sCD30. The majority of patients with pretransplant DSA might be transplanted safely without special pretreatment measures.
Kidney transplantation in the presence of donor-specific HLA antibodies (DSA) is associated with a high failure rate due to antibody-mediated rejection. Many centers avoid transplantations if DSA are present. Others perform such transplantations after removal of DSA by apheresis under potent immunosuppression. We provide strong evidence that DSA positive recipients reject their grafts at a high rate only if the immune activation marker sCD30 is also high, suggesting that T-cell help from an activated immune system is necessary for pretransplant DSA to exert a deleterious effect on the graft. High-risk patients with DSA and sCD30 may benefit from special treatment measures. The presence of DSA alone may not be deleterious. Background It is an unresolved issue why some kidney transplant recipients with pretransplant donor-specific HLA antibodies (DSA) show a high transplant failure rate, whereas in other patients DSA do not harm the graft. We investigated whether help from preactivated T-cells might be necessary for DSA to exert a deleterious effect. Methods The impact of pretransplant DSA and immune activation marker soluble CD30 (sCD30) on 3-year graft survival was analyzed in 385 presensitized kidney transplant recipients. Findings A deleterious influence of pretransplant DSA on graft survival was evident only in patients who were positive for the immune activation marker sCD30. In the absence of sCD30 positivity, 3-year graft survival was virtually identical in patients with or without DSA (83.1 ± 3.9% and 84.3 ± 2.8%, P = 0.81). A strikingly lower 3-year graft survival rate of 62.1 ± 6.4% was observed in patients who were both sCD30 and DSA positive (HR 2.92, P < 0.001). Even in the presence of strong DSA with ≥ 5000 MFI, the 3-year graft survival rate was high if the recipients were sCD30 negative. Interpretation Pretransplant DSA have a significantly deleterious impact on graft survival only in the presence of high pretransplant levels of the activation marker sCD30.
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Valke LLFG, van Cranenbroek B, Hilbrands LB, Joosten I. Soluble CD30 does not predict late acute rejection or safe tapering of immunosuppression in renal transplantation. Transpl Immunol 2014; 32:18-22. [PMID: 25446808 DOI: 10.1016/j.trim.2014.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Previous reports revealed the potential value of the soluble CD30 level (sCD30) as biomarker for the risk of acute rejection and graft failure after renal transplantation, here we examined its use for the prediction of safe tapering of calcineurin inhibitors as well as late acute rejection. METHODS In a cohort of renal transplant patients receiving triple immunosuppressive therapy we examined whether sCD30 can be used as a marker for safe (rejection-free) discontinuation of tacrolimus at six months after transplantation (TDS cohort: 24 rejectors and 44 non-rejecting controls). Also, in a second cohort of patients (n=22, rejectors n=11 and non-rejectors n=11), participating in a clinical trial of rituximab as induction therapy after renal transplantation (RITS cohort), we examined whether sCD30 could predict the occurrence of late (>3months post-transplant) acute rejection episodes. sCD30 was measured by ELISA in serum taken before and at several time points after transplantation. RESULTS Overall, in the TDS cohort sCD30 decreased after transplantation. No difference in sCD30 was observed between rejectors and non-rejecting controls at any of the time points measured. In addition, in the RITS cohort, sCD30 measured at three months after transplantation were not indicative for the occurrence of late acute rejection. CONCLUSION In two prospectively followed cohorts of renal transplant patients we found no association between sCD30 and the occurrence of either late acute rejection or acute rejection after reduction of immunosuppression.
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Affiliation(s)
- Lars L F G Valke
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Centre, PO Box 9101 6500HB Nijmegen, the Netherlands; Department of Nephrology, Radboud University Medical Centre, PO Box 9101 6500HB Nijmegen, the Netherlands.
| | - Bram van Cranenbroek
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Centre, PO Box 9101 6500HB Nijmegen, the Netherlands.
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Centre, PO Box 9101 6500HB Nijmegen, the Netherlands.
| | - Irma Joosten
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Centre, PO Box 9101 6500HB Nijmegen, the Netherlands.
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Cravedi P, Mannon RB. Noninvasive methods to assess the risk of kidney transplant rejection. Expert Rev Clin Immunol 2014; 5:535-546. [PMID: 20161000 DOI: 10.1586/eci.09.36] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In current clinical practice, immune reactivity of kidney transplant recipients is estimated by monitoring the levels of immunosuppressive drugs, and by functional and/or histological evaluation of the allograft. The availability of assays that could directly quantify the extent of the recipient's immune response towards the allograft would help clinicians to customize the prescription of immunosuppressive drugs to individual patients. Importantly, these assays might provide a more in-depth understanding of the complex mechanisms of acute rejection, chronic injury, and tolerance in organ transplantation, allowing the design of new and potentially more effective strategies for the minimization of immunosuppression, or even for the induction of immunological tolerance. The purpose of this review is to summarize results from recent studies in this field.
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Affiliation(s)
- Paolo Cravedi
- Mario Negri Institute for Pharmacological Research, Bergamo, Italy, Tel.: +39 035 453 5405, ,
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Abstract
BACKGROUND Survival of renal allografts is limited by chronic allograft deterioration resulting from processes that are difficult to detect in their early stages, when therapeutic interventions would be most effective. Predictive biomarkers from easily accessible specimens, such as blood or urine, might improve early diagnosis of smoldering graft-damaging processes and help with the identification of patients at particularly high risk of sustained injury, thereby helping to tailor therapy and appropriate follow-up screening. OBJECTIVE This article reviews recently investigated biomarkers for the prediction of renal allograft failure, outlines the new '-omic' technologies as a potential source for the identification of new predictive biomarkers and judges the practical value of predictive biomarkers at the present timepoint. METHODS A literature search was performed using the medical database PubMed. No general restrictions (e.g., year of publication) were applied, but the focus was set on more recently published articles. CONCLUSION Despite a large number of interesting studies, none of the investigated candidate biomarkers is robustly established for widespread clinical use or able to replace biopsies for graft assessment.
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Affiliation(s)
- Olaf Boenisch
- Harvard Medical School, Brigham and Woman's Hospital and Children's Hospital Boston, Transplantation Research Center, 221 Longwood Avenue, Boston, MA 02115, USA +1 617 732 5951 ; +1 617 732 6392 ;
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Hirt-Minkowski P, Roth M, Hönger G, Amico P, Hopfer H, Schaub S. Soluble CD30 correlates with clinical but not subclinical renal allograft rejection. Transpl Int 2012; 26:75-83. [DOI: 10.1111/j.1432-2277.2012.01578.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Roos M, Baumann M, Liu D, Heinemann FM, Lindemann M, Horn PA, Türk T, Lutz J, Heemann U, Witzke O, von Eynatten M. Low pre-transplant adiponectin multimers are associated with adverse allograft outcomes in kidney transplant recipients a 3-year prospective study. ACTA ACUST UNITED AC 2012; 178:11-5. [PMID: 22750635 DOI: 10.1016/j.regpep.2012.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 06/19/2012] [Indexed: 01/26/2023]
Abstract
BACKGROUND In kidney transplant recipients endothelial dysfunction is almost a universal risk factor for allograft failure. Adiponectin, an adipocyte derived hormone, has endothelial-protective properties and the high-molecular weight (HMW) multimer is the major active form, exerting anti-inflammatory and anti-apoptotic effects on endothelial cells. This study evaluated, whether pre-transplant total and HMW multimer adiponectin levels are associated with markers of endothelial dysfunction and arteriosclerosis and predict long-term graft survival in patients after kidney transplantation. METHODS In 206 renal transplant recipients pre-transplant total and HMW adiponectin levels were measured in serum by ELISA and Western blot, respectively. During the 36 months active follow up (median [interquartile range] 1249 [1020; 1445] days) 13 patients died (94% patient survival) and renal allograft failure was reported in 18 patients (91% graft survival). RESULTS Pre-transplant total and HMW adiponectin levels were significantly associated with lipid and glucose parameters at baseline. After 3 years follow-up pre-transplant total and HMW adiponectin levels were significantly inversely associated with the incidence of allograft failure (adiponectin: r=-0.216; p=0.002: HMW: r=-0.218; p=0.002). In multivariable adjusted Cox proportional hazard regression models patients in the lowest total and HMW adiponectin quartile had a significantly increased risk for allograft failure within 3 years post-transplantation: odds ratio [95%CI]: total adiponectin: 4.25 [1.27-14.24; p=0.019], and HMW multimers: 3.35 [1.04-10.76; p=0.042], respectively. CONCLUSION Low pre-transplant levels of total and HMW adiponectin reflect a pro-atherogenic endothelial milieu and independently predict an increased risk of allograft failure in kidney-transplant recipients. Measurement of adiponectin levels may identify patients at risk for adverse allograft outcomes after kidney transplantation.
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Affiliation(s)
- Marcel Roos
- Dept. of Nephrology, Technische Universität München, Munich, Germany.
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Sawitzki B, Schlickeiser S, Reinke P, Volk HD. Monitoring tolerance and rejection in organ transplant recipients. Biomarkers 2011; 16 Suppl 1:S42-50. [PMID: 21707443 DOI: 10.3109/1354750x.2011.578754] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
To avoid toxic side effects caused by permanent immunosuppressive treatment, research in transplantation focuses on new treatment strategies inducing tolerance or allowing drug weaning. Implementing drug minimization into clinical routine can be only safely achieved when guided by biomarkers reflecting the individual immune reactivity. We review recently described biomarkers and assays allowing identification of patients suitable for drug weaning or at risk of rejection. However, the majority of described biomarkers and assays have not been validated in prospective clinical trials. Thus, collaborative efforts are needed to design and perform prospective multicenter trials to validate the identified biomarkers across different laboratories.
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Affiliation(s)
- Birgit Sawitzki
- Institute of Medical Immunology, Charite University Medicine, Berlin, Germany.
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Heidt S, San Segundo D, Shankar S, Mittal S, Muthusamy ASR, Friend PJ, Fuggle SV, Wood KJ. Peripheral blood sampling for the detection of allograft rejection: biomarker identification and validation. Transplantation 2011; 92:1-9. [PMID: 21494177 DOI: 10.1097/tp.0b013e318218e978] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Currently, acute allograft rejection can only be detected reliably by deterioration of graft function confirmed by allograft biopsy. A huge drawback of this method of diagnosis is that substantial organ damage has already taken place at the time that rejection is diagnosed. Discovering and validating noninvasive biomarkers that predict acute rejection, and chronic allograft dysfunction, is of great importance. Many studies have investigated changes in the peripheral blood in an attempt to find biomarkers that reflect changes in the graft directly or indirectly. Herein, we will review the promises and limitations of the peripheral blood biomarkers that have been described in the literature so far.
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Affiliation(s)
- Sebastiaan Heidt
- Transplant Research Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Kovač J, Arnol M, Vidan Jeras B, Bren AF, Kandus A. Pretransplant soluble CD30 serum concentration does not affect kidney graft outcomes 3 years after transplantation. Transplant Proc 2011; 42:4043-6. [PMID: 21168622 DOI: 10.1016/j.transproceed.2010.09.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 09/16/2010] [Indexed: 11/25/2022]
Abstract
INTRODUCTION An elevated serum concentration of soluble the form of CD30 (sCD30), an activation marker of mainly T(H)2-type cytokines producing T lymphocytes, has been reported as a predictive factor for acute cellular rejection episodes and poor graft outcomes in kidney transplantation. This historic cohort study investigated the association of a pretransplant sCD30 serum concentrations with kidney graft function and graft survival 3 years posttransplantation in adult recipients of deceased donor kidney grafts, treated with monoclonal anti-CD25 antibodies as an induction treatment combined with a cyclosporine (CsA)-based maintenance triple therapy. MATERIALS AND METHODS The pretransplant sera of 296 recipients were tested for sCD30 content using a microsphere flow-cytometry assay. The estimated glomerular filtration rate (eGFR) was determined by the 4-variable Modification of Diet in Renal Disease equation. The incidences of graft loss were calculated with the use of Kaplan-Meier survival analysis and compared using the log-rank test. RESULTS According to the distribution of the pretransplant sCD30 levels concentration ≥2700 pg/mL was defined as high (n = 146) and concentration <2700 pg/mL as low (n = 150). Three years posttransplantation, the eGFR was not significantly different in the recipients in high and low sCD30 groups (65 ± 24 vs 67 ± 21 mL/min/1.73 m(2); P = .43); there was no association between the eGFR 3 years after transplantation and the pretransplant sCD30 levels (r(2) = 0.002; P = .49). Graft survival 3 years after transplantation was also not different in the recipients in high and low sCD30 groups (P = .52). CONCLUSION In our adult deceased-donor kidney graft recipients, the pretransplant sCD30 serum concentration was not a predictive factor of immunologic risk associated with the kidney graft function 3 years posttransplantation; neither did it affect graft survival 3 years after transplantation. The immunosuppression with anti-CD25 antibodies as an induction treatment combined with the CsA-based maintenance triple therapy could possibly be decisive for our findings.
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Affiliation(s)
- J Kovač
- Department of Nephrology, University Medical Center, Ljubljana, Slovenia.
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Haque T, Chaggar T, Schafers J, Atkinson C, McAulay KA, Crawford DH. Soluble CD30: a serum marker for Epstein-Barr virus-associated lymphoproliferative diseases. J Med Virol 2011; 83:311-6. [PMID: 21181928 DOI: 10.1002/jmv.21953] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The soluble form of CD30 (sCD30), a member of tumor necrosis factor receptor superfamily, has been used as a marker of disease activity in various lymphomas. Epstein-Barr virus (EBV) is a potent stimulator of CD30 expression. The study aims to evaluate whether sCD30 can be used as a diagnostic marker for EBV-associated infectious mononucleosis (IM) and post-transplant lymphoproliferative disease (PTLD). Plasma from EBV seropositive healthy controls (N = 90), acute IM patients (n = 90), non-PTLD heart/lung transplant recipients (N = 30) and EBV-positive PTLD patients (N = 23) was tested for sCD30 using a commercially available ELISA kit. EBV DNA was tested by real time quantitative polymerase chain reaction assay. Significantly higher sCD30 levels were observed in acute IM patients (median 242.9 ng/ml) compared to EBV seropositive controls (median 15.7 ng/ml; P < 0.0001). These levels were highest in IM patients within 14 days of onset of illness. PTLD patients had significantly higher sCD30 levels (median 94 ng/ml) than healthy controls (P < 0.0001) and transplant patients (median 27 ng/ml; P = 0.0007). EBV DNA was detected mostly in acute IM and PTLD patients. In both cases there was a significant correlation between sCD30 and EBV DNA levels in plasma (P < 0.0001). This study demonstrates that sCD30 and EBV DNA levels can be used as potential markers for diagnosis of IM and PTLD.
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Affiliation(s)
- Tanzina Haque
- Department of Virology, Royal Free Hospital, UCL Medical School, London, United Kingdom.
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Soluble CD30 and Hepatocyte growth factor as predictive markers of antibody-mediated rejection of the kidney allograft. Transpl Immunol 2011; 25:72-6. [PMID: 21376809 DOI: 10.1016/j.trim.2011.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 02/25/2011] [Accepted: 02/28/2011] [Indexed: 11/20/2022]
Abstract
UNLABELLED Our retrospective study was aimed to assess the relevance of pre- and post-transplant measurements of serum concentrations of the soluble CD30 molecule (soluble CD30, sCD30) and the cytokine Hepatocyte growth factor (HGF) for prediction of the risk for development of antibody-mediated rejection (AMR) in kidney transplant patients. Evaluation of sCD30, HGF levels and the presence of HLA-specific antibodies in a cohort of 205 patients was performed before, 2weeks and 6months after transplantation. Patients were followed up for kidney graft function and survival for two years. We found a tendency of higher incidence of AMR in retransplanted patients with elevated pre-transplant sCD30 (≥100U/ml) (p=0.051), however no such correlation was observed in first-transplant patients. Kidney recipients with simultaneously high sCD30 and HLA-specific antibodies (sCD30+/Ab+) before transplantation had significantly lower AMR-free survival compared to the other patient groups (p<0.001). HGF concentrations were not associated with the incidence of AMR at any time point of measurement, nevertheless, the combined analysis HGF and sCD30 showed increased incidence of AMR in recipients with elevated pretransplant sCD30 and low HGF levels. CONCLUSION the predictive value of pretransplant sCD30 for the development of antibody-mediated rejection after transplantation is significantly potentiated by the co-presence of HLA specific antibodies. The role of HGF as a rejection-protective factor in patients with high pretransplant HGF levels would need further investigation.
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Roos M, Heinemann FM, Lindemann M, Horn PA, Lutz J, Stock K, Thürmel K, Baumann M, Witzke O, Heemann U. Fetuin-A Pretransplant Serum Levels, Kidney Allograft Function and Rejection Episodes: A 3-Year Posttransplantation Follow-Up. ACTA ACUST UNITED AC 2011; 34:328-33. [DOI: 10.1159/000327848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 03/27/2011] [Indexed: 01/11/2023]
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Hire K, Hering B, Bansal-Pakala P. Relative reductions in soluble CD30 levels post-transplant predict acute graft function in islet allograft recipients receiving three different immunosuppression protocols. Transpl Immunol 2010; 23:209-14. [DOI: 10.1016/j.trim.2010.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 05/21/2010] [Accepted: 06/11/2010] [Indexed: 12/01/2022]
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Juan Alberto Fierro C. Monitoreo inmunológico: el comienzo de una nueva era en trasplantes. REVISTA MÉDICA CLÍNICA LAS CONDES 2010. [DOI: 10.1016/s0716-8640(10)70529-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
PURPOSE OF REVIEW Despite the introduction of advanced immunosuppressive drug therapies, clinical and subclinical rejections still occur in many graft recipients with a negative impact on the long-term transplant outcome. The immunological status of the patients awaiting the transplantation is a key factor for these processes. Here we summarize the recent efforts to identify and develop biomarkers and functional assays that allow an individual pretransplant risk assessment. RECENT FINDINGS New sensitive techniques assessing T-cell memory and B-cell activation have been developed. Furthermore, the expression level of soluble and molecular markers reflecting the activation state of the immune system and donor graft intrinsic factors have been shown to influence graft outcome. SUMMARY A variety of parameters and assays that determine the pretransplant immune activation status has been developed. Some of these assays have already been used prospectively to define high-risk patients receiving advanced immunosuppressive induction therapy.However, the conflicting results obtained in different studies show that biomarker analysis and functional assays performance need to be further standardized and validated in large prospective trials before they can be routinely implemented into a pretransplant risk assessment. Subsequently, a combined effort to design pretransplant risk stratification algorithms should lead to personalized immunosuppressive treatment regimes and improved graft survival and long-term graft function.
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Post-transplant increased levels of serum sCD30 is a marker for prediction of kidney allograft loss in a 5-year prospective study. Transpl Immunol 2009; 22:1-4. [DOI: 10.1016/j.trim.2009.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 09/11/2009] [Accepted: 09/11/2009] [Indexed: 11/20/2022]
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Soluble CD30 Levels in Recipients Undergoing Heart Transplantation Do Not Predict Post-transplant Outcome. J Heart Lung Transplant 2009; 28:1206-10. [DOI: 10.1016/j.healun.2009.05.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Revised: 05/29/2009] [Accepted: 05/30/2009] [Indexed: 11/23/2022] Open
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Can We Use Biomarkers and Functional Assays to Implement Personalized Therapies in Transplantation? Transplantation 2009; 87:1595-601. [DOI: 10.1097/tp.0b013e3181a6b2cf] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kovac J, Arnol M, Vidan-Jeras B, Bren A, Kandus A. Does Pretransplant Soluble CD30 Serum Concentration Affect Deceased-Donor Kidney Graft Function 3 Years After Transplantation? Transplant Proc 2008; 40:1357-61. [DOI: 10.1016/j.transproceed.2008.03.092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 10/28/2007] [Accepted: 03/03/2008] [Indexed: 10/21/2022]
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Investigations Into the Feed-Back Mechanism Between Spermatogenesis and Gonadotropin Level in Man. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1970. [DOI: 10.1007/978-1-4615-9008-8_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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