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Valentin MO, Crespo M, Fernandez C, Muro M, Vega R, Palou E, Ruiz JC, Diekman F, Padilla M, Mancebo E, Perez I, Andres A, Ontañon J, Dominguez-Gil B. Improving the Access of Highly Sensitized Patients to Kidney Transplantation From Deceased Donors: The Spanish PATHI Program With Allocation Based on the Virtual Crossmatch. Transplantation 2024; 108:787-801. [PMID: 37867239 DOI: 10.1097/tp.0000000000004824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND In 2015, the Spanish National Transplant Organization developed a prioritization system (Program for Access to Transplantation for Highly Sensitized Patients [PATHI]) to increase transplant options for patients with calculated panel-reactive antibodies (cPRAs) ≥98%, based on virtual crossmatch. We describe the experience with the implementation of PATHI and assess its efficacy. METHODS PATHI registry was used to collect characteristics of donors and patients between June 15, 2015, and March 1, 2018. One-year graft and patient survival and acute rejection were also measured. A Cox model was used to identify factors related to patient death and graft loss and logistical regression for those associated with rejection. RESULTS One thousand eighty-nine patients were included, and 272 (25%) were transplanted. Transplant rate by cPRA was 54.9%, 40.5%, and 12.8% in patients with cPRA98%, cPRA99%, and cPRA100%, respectively. One-year patient survival was 92.5%. Recipient age ≥60, time under dialysis >7 y, and delayed graft function were mortality risk factors. One-year graft survival was 88.7%. The factor related to graft loss was delayed graft function. The rejection rate was 22%. Factors related to rejection were sex, older recipients, and posttransplant donor-specific antibodies. CONCLUSIONS A prioritization approach increases transplant options for highly sensitized patients with appropriate short-term postransplant outcomes. Along with other programs, PATHI may inspire other countries to adopt strategies to meet transplant needs of these patients.
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Affiliation(s)
- Maria O Valentin
- Nephrology Department, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain
| | - Marta Crespo
- Nephrology Department, Hospital De Mar, Barcelona, Spain
| | - Constantino Fernandez
- Nephrology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Manuel Muro
- Immunology Department, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Rocio Vega
- Transplant Coordination Department, Organización Nacional de Trasplantes, Madrid, Spain
| | - Eduard Palou
- Immunology Department, Hospital Clinic, Barcelona, Spain
| | - Juan Carlos Ruiz
- Nephrology Department, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain
| | - Fritz Diekman
- Nephrology Department, Hospital Clinic, Barcelona, Spain
| | - Maria Padilla
- Immunology Department, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Esther Mancebo
- Immunology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Isabel Perez
- Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain
| | - Amado Andres
- Nephrology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Jesus Ontañon
- Immunology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Beatriz Dominguez-Gil
- Immunology Department, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
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Laboux T, Lenain R, Visentin J, Flahaut G, Chamley P, Provôt F, Top I, Kerleau C, Labalette M, Choukroun G, Couzi L, Blancho G, Hazzan M, Maanaoui M. Impact of Preformed Donor-Specific Anti-HLA-Cw and Anti-HLA-DP Antibodies on Acute Antibody-Mediated Rejection in Kidney Transplantation. Transpl Int 2023; 36:11416. [PMID: 38076227 PMCID: PMC10698113 DOI: 10.3389/ti.2023.11416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/02/2023] [Indexed: 12/18/2023]
Abstract
Given the risk of rejection, the presence of preformed donor specific antibodies (DSA) contraindicates transplantation in most allocation systems. However, HLA-Cw and -DP DSA escape this censorship. We performed a multicentric observational study, in which the objective was to determinate risk factors of acute antibody-mediated rejection (aABMR) in recipients transplanted with preformed isolated Cw- or DP-DSA. Between 2010 and 2019, 183 patients were transplanted with a preformed isolated Cw- or DP-DSA (92 Cw-DSA; 91 DP-DSA). At 2 years, the incidence of aABMR was 12% in the Cw-DSA group, versus 28% in the DP-DSA group. Using multivariable Cox regression model, the presence of a preformed DP-DSA was associated with an increased risk of aABMR (HR = 2.32 [1.21-4.45 (p = 0.001)]) compared with Cw-DSA. We also observed a significant association between the DSA's MFI on the day of transplant and the risk of aABMR (HR = 1.09 [1.08-1.18], p = 0.032), whatever the DSA was. Interaction term analysis found an increased risk of aABMR in the DP-DSA group compared with Cw-DSA, but only for MFI below 3,000. These results may plead for taking these antibodies into account in the allocation algorithms, in the same way as other DSA.
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Affiliation(s)
- Timothée Laboux
- Department of Nephrology, Kidney Transplantation and Dialysis, CHU Lille, University of Lille, Lille, France
- INSERM U1167, RID-AGE, University of Lille, Lille, France
| | - Rémi Lenain
- Department of Nephrology, Kidney Transplantation and Dialysis, CHU Lille, University of Lille, Lille, France
- INSERM UMR 1246 – SPHERE, Nantes University, Tours University, Nantes, France
| | - Jonathan Visentin
- Department of Immunology and Immunogenetics, CHU Bordeaux, Bordeaux, France
- ImmunoConceEpT, CNRS UMR5164, Inserm ERL U1303, University of Bordeaux, Bordeaux, France
| | - Gauthier Flahaut
- Department of Nephrology, Internal Medicine, Dialysis and Transplantation, CHU Amiens, Jules Verne University of Picardie, Amiens, France
- EA7517, MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
| | - Paul Chamley
- Department of Nephrology, CH Roubaix, Roubaix, France
| | - François Provôt
- Department of Nephrology, Kidney Transplantation and Dialysis, CHU Lille, University of Lille, Lille, France
| | - Isabelle Top
- Department of Immunology-HLA, CHU Lille, University of Lille, Lille, France
| | - Clarisse Kerleau
- CHU Nantes, Service de Néphrologie-Immunologie Clinique, ITUN, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, France
| | - Myriam Labalette
- Department of Immunology-HLA, CHU Lille, University of Lille, Lille, France
- INSERM UMR1286, INFINITE, University of Lille, Lille, France
| | - Gabriel Choukroun
- Department of Nephrology, Internal Medicine, Dialysis and Transplantation, CHU Amiens, Jules Verne University of Picardie, Amiens, France
- EA7517, MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
| | - Lionel Couzi
- ImmunoConceEpT, CNRS UMR5164, Inserm ERL U1303, University of Bordeaux, Bordeaux, France
- Department of Nephrology, Transplantation, Dialysis and Apheresis, CHU Bordeaux, Bordeaux, France
| | - Gilles Blancho
- CHU Nantes, Service de Néphrologie-Immunologie Clinique, ITUN, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, France
| | - Marc Hazzan
- Department of Nephrology, Kidney Transplantation and Dialysis, CHU Lille, University of Lille, Lille, France
| | - Mehdi Maanaoui
- Department of Nephrology, Kidney Transplantation and Dialysis, CHU Lille, University of Lille, Lille, France
- INSERM U1190, EGID, Institut Pasteur Lille, CHU Lille, University of Lille, Lille, France
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Bansal SB, Gade A, Sinha S, Mahapatra A, Jha P, Sethi SK. HLA Desensitization Based on Results of the Luminex Technique in Kidney Transplant - A Single-center Experience. Indian J Nephrol 2021; 31:454-459. [PMID: 34880555 PMCID: PMC8597796 DOI: 10.4103/ijn.ijn_237_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/19/2020] [Accepted: 09/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background: There is little experience of human leucocyte antigen (HLA) desensitization in India based on the Luminex single-antigen bead (SAB) testing. We retrospectively analyzed our patients, who underwent HLA desensitization based on Luminex SAB results. Method: Between 2014 and 2018, patients with complement-dependent cytotoxicity cross-match (CDC-XM) negativity but flow cytometry crossmatch (FC-XM) positivity were further analyzed with Luminex SAB for donor-specific antibodies (DSAs). A total of 12 patients who had DSA mean fluorescent intensity (MFI) of >1000 and <10,000 were included in the study. Our protocol for desensitization consisted of plasmapheresis (PP) followed by low dose intravenous immunoglobulin (IV IG) 100 mg/kg and induction with antithymocyte globulin (ATG). Patients were taken for transplant when either MFI was <1000 and/or FC-XM was negative. Results: All 12 patients were first transplant and 10 had a history of some sensitizing event; pregnancy in 4, blood transfusions in 4, and both in 2 patients. FC-XM was positive for T-cell in 4, B-cell in 6, and both in 2 patients. On evaluation by Luminex SAB, 6 patients had MFI from 1000 to 2000, and 6 had MFI of >2000. All underwent desensitization successfully. Two patients had an increase in posttransplant DSA titers requiring posttransplant PP. The mean follow-up was 26.6 ± 13.9 months. On follow-up, only one patient developed acute T cell-mediated rejection 1 year after transplant, which responded to pulse steroids. There was no graft or patient loss until the last follow-up. Conclusion: This study shows that HLA desensitization is feasible and successful in the Indian setting if patients are properly selected.
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Affiliation(s)
- S B Bansal
- Department of Nephrology, Medanta Kidney and Urology Institute, Medanta-Medicity, Gurugram, Haryana, India
| | - A Gade
- Department of Nephrology, Medanta Kidney and Urology Institute, Medanta-Medicity, Gurugram, Haryana, India
| | - S Sinha
- Department of Nephrology, BYL Nair Hospital, Mumbai, Maharashtra, India
| | - A Mahapatra
- Department of Nephrology, Medanta Kidney and Urology Institute, Medanta-Medicity, Gurugram, Haryana, India
| | - P Jha
- Department of Nephrology, Medanta Kidney and Urology Institute, Medanta-Medicity, Gurugram, Haryana, India
| | - S K Sethi
- Department of Nephrology, Medanta Kidney and Urology Institute, Medanta-Medicity, Gurugram, Haryana, India
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Sypek MP, Kausman JY, Watson N, Wyburn K, Holt SG, Hughes P, Clayton PA. The Introduction of cPRA and Its Impact on Access to Deceased Donor Kidney Transplantation for Highly Sensitized Patients in Australia. Transplantation 2021; 105:1317-1325. [PMID: 34019363 DOI: 10.1097/tp.0000000000003410] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In March 2016, Australia's deceased donor kidney allocation program introduced calculated panel reactive antibody (cPRA) based on antibody exclusions using multiplex assays to define sensitization for waitlisted candidates. We aimed to assess the impact of this change and review access to transplantation for highly sensitized patients under the current allocation rules. METHODS Registry data were used to reconstruct changes in panel reactive antibody (PRA)/cPRA for all patients active on the waiting list between 2013 and 2018. A multilevel, mixed-effects negative binomial regression model was used to determine the association between sensitization and transplantation rate in the cPRA era. RESULTS Following the introduction of cPRA, there was an increase in the percentage of the waiting list classified as highly sensitized (PRA/cPRA ≥80%) from 7.2% to 27.8% and very highly sensitized (PRA/cPRA ≥99%) from 2.7% to 15.3%. Any degree of sensitization was associated with a decreased rate of transplantation with a marked reduction for those with cPRA 95%-98% (adjusted incidence rate ratio, 0.36 [95% confidence interval, 0.28-0.47], P < 0.001) and cPRA ≥99% (adjusted incidence rate ratio, 0.09 [95% confidence interval, 0.07-0.12], P < 0.001). CONCLUSIONS The proportion of the waiting list classified as highly sensitized increased substantially following the introduction of cPRA, and despite current prioritization, very highly sensitized patients have markedly reduced access to deceased donor transplantation.
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Affiliation(s)
- Matthew P Sypek
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Australia
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Nephrology, Royal Children's Hospital, Melbourne, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Joshua Y Kausman
- Department of Nephrology, Royal Children's Hospital, Melbourne, Australia
- Clinical Paediatrics, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Narelle Watson
- Transplantation and Immunogenetics Services, Australian RedCross Lifeblood, Brisbane, Australia
| | - Kate Wyburn
- Royal Prince Alfred Hospital and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Stephen G Holt
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Australia
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia
| | - Peter Hughes
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Australia
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
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Karafin MS, Schumacher C, Zhang J, Simpson P, Johnson ST, Pierce KL. Human leukocyte antigen (HLA)-incompatible mean fluorescence intensity-selected platelet products have corrected count increments similar to HLA antigen-matched platelets. Transfusion 2021; 61:2307-2316. [PMID: 34075590 DOI: 10.1111/trf.16430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Donor specific antibody sum mean fluorescence intensity (MFI) values have been successfully used in transplant medicine to assess risk for organ rejection. However, little is known regarding whether MFI values could be similarly used to aid in platelet product selection. We have developed a novel protocol where MFI values are used to offer human leukocyte antigen (HLA)-incompatible platelet products when HLA antigen-matched products are not available. We aimed to evaluate the efficacy of this protocol. METHODS We performed a 4-year retrospective chart review for all patients who received at least one MFI-selected platelet product. A corrected count increment (CCI) was calculated for each transfusion event. A mixed effects model was used to investigate the association between CCIs for MFI-selected, HLA antigen matched, and random donor platelet transfusions. A random effects expectation-maximization regression tree was used to define the extent to which other patient variables, such as age, sex, and diagnosis impacted the CCI for each platelet transfusion. RESULTS Twenty highly HLA alloimmunized patients received a total of 591 platelets. MFI-selected platelet (low MFI) transfusions had a significantly higher median CCI 0-6 hour post-transfusion (13,559, interquartile range [IQR]: 8275-18,736) compared to random donor platelets (2121, IQR: 0-10,368, p < 0.0001). There was no significant difference in median CCI between HLA antigen matched and MFI selected platelet transfusions (p = 0.2). Mixed effects and regression modeling revealed that MFI-selected platelet products had a significantly higher CCI than non-matched platelets, even when accounting for other significant patient variables. CONCLUSION MFI-selected HLA-incompatible platelet products could provide a comparable alternative to traditional HLA antigen-matched platelet products.
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Affiliation(s)
- Matthew S Karafin
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Jian Zhang
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Section of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pippa Simpson
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Section of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Susan T Johnson
- Diagnostic Laboratories, Versiti Wisconsin, Milwaukee, Wisconsin, USA
| | - Karen L Pierce
- Diagnostic Laboratories, Versiti Wisconsin, Milwaukee, Wisconsin, USA
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Measuring human leukocyte antigen alloantibodies: beyond a binary decision. Curr Opin Organ Transplant 2021; 25:529-535. [PMID: 33055530 DOI: 10.1097/mot.0000000000000822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Accurate measurement of human leukocyte antigen antibodies is critical for making clinical decisions treating patients awaiting transplantation or monitoring them post transplantation. Single antigen bead assay results are given as Mean Fluorescence Intensity, falling short of providing the required quantitative measure. RECENT FINDINGS Titration studies were shown to circumvent the limitation of target-saturation that affect interpretation of single antigen bead assays especially in highly sensitized patients with strong antibodies. In fact, titration information can serve to measure efficacy of antibody removal during pretransplant desensitization using plasmapheresis/intravenous immunoglobulin (PP/IVIg) approaches. Moreover, recent studies indicate that knowing the donor-specific antibody titer has prognostic value that can guide PP/IVIg desensitization treatments. Newer data demonstrates an additional layer of information obtained by titration studies allowing to stratify patients with very high cPRA (>99%) based on the strength of the antibodies present, rather than the breadth. This data can thereby identify patients that are more likely to benefit from desensitization approaches on the transplant wait-list. SUMMARY Titration studies have a prognostic value with regards to quantifying antibody strength. Obtaining this information does not require performing the complete set of dilutions. In fact, performing two to three specific dilutions can provide relevant information while maintaining practical cost.
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Anglicheau D, Tinel C, Canaud G, Loupy A, Zuber J, Delville M, Rabaté C, Scemla A, Snanoudj R, Sberro-Soussan R, Mamzer-Bruneel MF, Bererhi L, Martinez F, Timsit MO, Rabant M, Correas JM, Bienaimé F, Duong JP, Hélénon O, Prié D, Méjean A, Legendre C. [Renal transplantation: Procedure and early follow-up]. Nephrol Ther 2019; 15:469-484. [PMID: 31640943 DOI: 10.1016/j.nephro.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
More than fifty years after the success of the two first renal transplantations in Boston and in Necker hospital in Paris, renal transplantation became the treatment of choice of end stage renal failure, because it improves not only the quality of life of the patients but also their long-term survival. In France, more than 3,700 kidney transplantations are performed every year and more than 40,000 patients are living with a functioning kidney allograft. This treatment of end stage renal disease requires a fine-tuned pre-transplant evaluation and a multidisciplinary post-transplant care in order to prevent, to detect and to treat comorbidities and complications of immunosuppression. The ambition of this manuscript is not to describe in an exhaustive way all the aspects of renal transplantation but starting from the experience of a team, recently published data, and national and international guidelines, to try to provide a synthetic and chronological view of the early post-transplant monitoring.
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Affiliation(s)
- Dany Anglicheau
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
| | - Claire Tinel
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Guillaume Canaud
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Alexandre Loupy
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Julien Zuber
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Marianne Delville
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Clémentine Rabaté
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Anne Scemla
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France
| | - Renaud Snanoudj
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France
| | - Rébecca Sberro-Soussan
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France
| | | | - Lynda Bererhi
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France
| | - Frank Martinez
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France
| | - Marc-Olivier Timsit
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Marion Rabant
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'anatomie pathologique, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Jean-Michel Correas
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de radiologie adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Frank Bienaimé
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'exploration fonctionnelle, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Jean-Paul Duong
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'anatomie pathologique, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Olivier Hélénon
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de radiologie adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Dominique Prié
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'exploration fonctionnelle, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Arnaud Méjean
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Christophe Legendre
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
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Pinelli DF, Zachary AA, Friedewald JJ, Gjertson DW, Evans MA, Chatroop EN, Leffell MS, Vo AA, Jordan SC, Montgomery RA, Tambur AR. Prognostic tools to assess candidacy for and efficacy of antibody-removal therapy. Am J Transplant 2019; 19:381-390. [PMID: 29981209 DOI: 10.1111/ajt.15007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/20/2018] [Accepted: 07/01/2018] [Indexed: 01/25/2023]
Abstract
Currently, the ability to predict or monitor the efficacy of HLA antibody-removal therapies is deficient. We previously reported that titration studies are a consistent and accurate means of assessing antibody strength. To test whether titration studies can also predict which patients are better candidates for desensitization, we studied 38 patients from 3 centers (29 receiving plasmapheresis/low-dose intravenous immunoglobulin [IVIg]; 9 patients receiving high-dose IVIg). For patients undergoing plasmapheresis/low-dose IVIg, antibody titer reduction correlated with number of treatment cycles for both class I and II antibodies but only up to approximately 4 cycles. Reduction in titer slowed with additional cycles, suggesting a limit to the efficacy of this approach. Furthermore, initial titer (predesensitization) can guide the selection of candidates for successful antibody-removal treatment. In our experience, patients with antibodies at an initial titer >1:512 could not be reduced to the goal of a negative lymphocyte crossmatch, corresponding to a 1:16 titer, despite a significant increase in the number of treatment cycles. Change in mean fluorescence intensity (MFI) value did not correlate with success of treatment if initial MFI values were >10 000, likely due to single antigen bead saturation. Overall, we present a potential prognostic tool to predict candidacy and a monitoring tool to assess efficacy of desensitization treatment.
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Affiliation(s)
- David F Pinelli
- Division of Transplant Surgery, Northwestern University Feinberg School of Medicine, Comprehensive Transplant Center, Chicago, IL, USA
| | - Andrea A Zachary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John J Friedewald
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - David W Gjertson
- Division of Biostatistics, University of California, Los Angeles School of Public Health, Los Angeles, CA, USA
| | - Michelle A Evans
- Division of Transplant Surgery, Northwestern University Feinberg School of Medicine, Comprehensive Transplant Center, Chicago, IL, USA
| | - Erik N Chatroop
- Division of Transplant Surgery, Northwestern University Feinberg School of Medicine, Comprehensive Transplant Center, Chicago, IL, USA
| | - Mary S Leffell
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ashley A Vo
- Cedars-Sinai Medical Center, Comprehensive Transplant Center, Los Angeles, CA, USA
| | - Stanley C Jordan
- Cedars-Sinai Medical Center, Comprehensive Transplant Center, Los Angeles, CA, USA
| | - Robert A Montgomery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anat R Tambur
- Division of Transplant Surgery, Northwestern University Feinberg School of Medicine, Comprehensive Transplant Center, Chicago, IL, USA
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Persaud SP, Duffy B, Phelan DL, Mohanakumar T, Delos Santos R, Gaut JP, Liu C. Accelerated humoral renal allograft rejection due to HLA-C14 mediated allosensitization to HLA-Bw6. Hum Immunol 2017; 78:692-698. [DOI: 10.1016/j.humimm.2017.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/25/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
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11
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Ziemann M, Heßler N, König IR, Lachmann N, Dick A, Ditt V, Budde K, Reinke P, Eisenberger U, Suwelack B, Klein T, Westhoff TH, Arns W, Ivens K, Habicht A, Renders L, Stippel D, Bös D, Sommer F, Görg S, Nitschke M, Feldkamp T, Heinemann FM, Kelsch R. Unacceptable human leucocyte antigens for organ offers in the era of organ shortage: influence on waiting time before kidney transplantation. Nephrol Dial Transplant 2017; 32:880-889. [DOI: 10.1093/ndt/gfw462] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/29/2016] [Indexed: 11/12/2022] Open
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12
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13
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Reynolds BC, Tinckam KJ. Sensitization assessment before kidney transplantation. Transplant Rev (Orlando) 2017; 31:18-28. [DOI: 10.1016/j.trre.2016.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 10/05/2016] [Indexed: 01/28/2023]
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14
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Cross AR, Lion J, Loiseau P, Charron D, Taupin JL, Glotz D, Mooney N. Donor Specific Antibodies are not only directed against HLA-DR: Minding your Ps and Qs. Hum Immunol 2016; 77:1092-1100. [PMID: 27060781 DOI: 10.1016/j.humimm.2016.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 03/08/2016] [Accepted: 04/04/2016] [Indexed: 12/30/2022]
Abstract
During solid organ transplantation, interactions between recipient and donor immune cells occur chiefly in the allograft microvasculature. All three HLA class II antigens, DR, DP and DQ, have been detected on renal EC with a markedly increased expression of HLA class II observed in renal allografts undergoing rejection. Recent studies of donor-specific antibodies (DSA) have exposed the prevalence of de novo DSA directed against HLA-DQ, as well as a strong association between these antibodies and allograft damage. The HLA-DQ molecule can be distinguished from the other class II antigens by its transcription, expression and peptide repertoire. The distinct intragraft expression and immunogenicity of HLA-DQ may contribute to the incidence of HLA-DQ DSA, as well as directing the DSA-mediated damage. The possibility of HLA class II antigen-specific signaling in EC may reveal different mechanisms of allograft damage that act in tandem with complement-dependent injury. This review addresses the features of the HLA-DQ heterodimer that may underlie the high incidence of HLA-DQ directed DSA and their association with allograft damage. We also consider existing data in hematopoietic stem cell transplantation concerning HLA directed DSA.
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Affiliation(s)
- Amy R Cross
- INSERM UMRs 1160, Institut Universitaire d'Hématologie, Université Paris Diderot, Hôpital Saint Louis, Paris 75010, France; LabEx Transplantex, AP-HP, Hôpital Saint-Louis, Paris 75010, France
| | - Julien Lion
- INSERM UMRs 1160, Institut Universitaire d'Hématologie, Université Paris Diderot, Hôpital Saint Louis, Paris 75010, France; LabEx Transplantex, AP-HP, Hôpital Saint-Louis, Paris 75010, France
| | - Pascale Loiseau
- INSERM UMRs 1160, Institut Universitaire d'Hématologie, Université Paris Diderot, Hôpital Saint Louis, Paris 75010, France; LabEx Transplantex, AP-HP, Hôpital Saint-Louis, Paris 75010, France; Laboratoire de Histocompatibilité, Hôpital Saint Louis, Paris 75010, France
| | - Dominique Charron
- Laboratoire de Histocompatibilité, Hôpital Saint Louis, Paris 75010, France; Université Paris Diderot, Sorbonne Paris Cité, F-75013, France
| | - Jean-Luc Taupin
- INSERM UMRs 1160, Institut Universitaire d'Hématologie, Université Paris Diderot, Hôpital Saint Louis, Paris 75010, France; LabEx Transplantex, AP-HP, Hôpital Saint-Louis, Paris 75010, France; Laboratoire de Histocompatibilité, Hôpital Saint Louis, Paris 75010, France; Université Paris Diderot, Sorbonne Paris Cité, F-75013, France
| | - Denis Glotz
- INSERM UMRs 1160, Institut Universitaire d'Hématologie, Université Paris Diderot, Hôpital Saint Louis, Paris 75010, France; LabEx Transplantex, AP-HP, Hôpital Saint-Louis, Paris 75010, France; Service de Néphrologie et Transplantation, Hôpital Saint Louis, Paris 75010, France; Université Paris Diderot, Sorbonne Paris Cité, F-75013, France
| | - Nuala Mooney
- INSERM UMRs 1160, Institut Universitaire d'Hématologie, Université Paris Diderot, Hôpital Saint Louis, Paris 75010, France; LabEx Transplantex, AP-HP, Hôpital Saint-Louis, Paris 75010, France.
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15
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Baxter-Lowe LA, Kucheryavaya A, Tyan D, Reinsmoen N. CPRA for allocation of kidneys in the US: More candidates ≥98% CPRA, lower positive crossmatch rates and improved transplant rates for sensitized patients. Hum Immunol 2016; 77:395-402. [PMID: 27012168 DOI: 10.1016/j.humimm.2016.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 03/04/2016] [Accepted: 03/08/2016] [Indexed: 02/06/2023]
Abstract
In 2009 calculated panel reactive antibody (CPRA) replaced PRA as the metric for HLA sensitization in the US kidney allocation system. During the next four years, registrants with at least one unacceptable antigen increased (34-40%) and registrants with ≥98% PRA/CPRA increased from 7% to 9% of the waitlist. These changes were accompanied by a reduction in kidney offers refused for positive crossmatch: 14,137 (1.7%) in 2009 and 3,310 in 2013 (0.4%). Registrants with ≥98% PRA/CPRA had highest rates of refusal but also showed substantial improvement (20% in 2009 vs 8% in 2013). For registrants with ≥98% PRA/CPRA, 45% of accepted offers in 2009 were not transplanted into the intended recipient compared to 11% in 2013. Transplant rates remained low for these patients (∼50/1000 active patient-years), but rates improved for patients with 80-97% PRA/CPRA (223/1000 active patient-years in 2009 vs 354/1000 in 2013). In 2013, 40% regraft candidates had CPRA ≥98% compared to 4% of primary graft candidates. More females than males were ≥98% CPRA (14% vs 7%) and more females had CPRA above 0 (50% vs 28%). In the CPRA era, listing of unacceptable antigens increased, positive crossmatches were diminished and transplant rates for sensitized patients improved.
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Affiliation(s)
- Lee Ann Baxter-Lowe
- Children's Hospital Los Angeles and University of Southern California, Los Angeles, CA, United States.
| | | | - Dolly Tyan
- Stanford University, Palo Alto, CA, United States
| | - Nancy Reinsmoen
- Cedars-Sinai and University of California Los Angeles, Los Angeles, CA, United States
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16
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Mehrotra S, Sharma R, Prasad N, Gupta A, Bhadauria D, Kaul A, Jain M, Rishishwar P. The importance of donor-specific anti-HLA antibodies (DSA) identification in renal transplant patients with C4d-negative biopsies. INDIAN JOURNAL OF TRANSPLANTATION 2016. [DOI: 10.1016/j.ijt.2016.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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17
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Malard-Castagnet S, Dugast E, Degauque N, Pallier A, Soulillou JP, Cesbron A, Giral M, Harb J, Brouard S. Sialylation of antibodies in kidney recipients with de novo donor specific antibody, with or without antibody mediated rejection. Hum Immunol 2015; 77:1076-1083. [PMID: 26546874 DOI: 10.1016/j.humimm.2015.10.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 10/06/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND DSA are associated with reduced long-term transplant function and increased prevalence of chronic rejection in some patients, whereas others do not: our goal was to determine whether the sialylation of IgG and DSA could help to explain in these last cases their "non-aggressive" and/or "protective" biological activity. METHODS The sialylation level of total IgG in blood from two groups of kidney-transplant patients with de novo DSA, one with an AMR (DSA+AMR+), and the other without were studied. RESULTS In the DSA+AMR- patients total IgG were more sialylated at time of transplant, and at the first detection of DSA, class I DSA were 2.6-fold more sialylated (mean 9.943±1.801 versus 3.898±2.475, p=0.058); DSA+AMR+ patients exhibited higher levels of class II DSA. CONCLUSIONS In our study, higher levels of sialylated IgG are detectable on day of transplant in patients who do not develop AMR, they have higher sialylated class I DSA at the initial detection of DSA, whereas class II DSA are significantly higher in patients who develop AMR. This is the first report suggesting that transplant outcome, and particularly AMR, is associated with levels of sialylated IgG antibodies. Our data suggest that DSA are functionally heterogeneous and that further studies with an enlarged cohort may improve our understanding of their clinical impact.
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Affiliation(s)
- Stéphanie Malard-Castagnet
- Etablissement Français du sang, Pays de la Loire, HLA Laboratory, 34 Boulevard Jean Monnet, 44011 Nantes, France; Institut National de la Sante Et de la Recherche Médicale INSERM U1064, and Institut de Transplantation Urologie Néphrologie du Centre Hospitalier Universitaire Hôtel Dieu, LabEx Transplantex, CHU de Nantes, 30 Boulevard Jean Monnet, 44093 Nantes Cedex 01, France.
| | - Emilie Dugast
- Institut National de la Sante Et de la Recherche Médicale INSERM U1064, and Institut de Transplantation Urologie Néphrologie du Centre Hospitalier Universitaire Hôtel Dieu, LabEx Transplantex, CHU de Nantes, 30 Boulevard Jean Monnet, 44093 Nantes Cedex 01, France; Université de Nantes, Faculté de Médecine, Nantes, France.
| | - Nicolas Degauque
- Institut National de la Sante Et de la Recherche Médicale INSERM U1064, and Institut de Transplantation Urologie Néphrologie du Centre Hospitalier Universitaire Hôtel Dieu, LabEx Transplantex, CHU de Nantes, 30 Boulevard Jean Monnet, 44093 Nantes Cedex 01, France; Université de Nantes, Faculté de Médecine, Nantes, France.
| | - Annaïck Pallier
- Institut National de la Sante Et de la Recherche Médicale INSERM U1064, and Institut de Transplantation Urologie Néphrologie du Centre Hospitalier Universitaire Hôtel Dieu, LabEx Transplantex, CHU de Nantes, 30 Boulevard Jean Monnet, 44093 Nantes Cedex 01, France.
| | - Jean Paul Soulillou
- Institut National de la Sante Et de la Recherche Médicale INSERM U1064, and Institut de Transplantation Urologie Néphrologie du Centre Hospitalier Universitaire Hôtel Dieu, LabEx Transplantex, CHU de Nantes, 30 Boulevard Jean Monnet, 44093 Nantes Cedex 01, France; Université de Nantes, Faculté de Médecine, Nantes, France.
| | - Anne Cesbron
- Etablissement Français du sang, Pays de la Loire, HLA Laboratory, 34 Boulevard Jean Monnet, 44011 Nantes, France.
| | - Magali Giral
- Institut National de la Sante Et de la Recherche Médicale INSERM U1064, and Institut de Transplantation Urologie Néphrologie du Centre Hospitalier Universitaire Hôtel Dieu, LabEx Transplantex, CHU de Nantes, 30 Boulevard Jean Monnet, 44093 Nantes Cedex 01, France; Université de Nantes, Faculté de Médecine, Nantes, France; CIC Biothérapie, 5, allée de l'Ile Gloriette, 44093 Nantes Cedex 0144035, Nantes, France; CHU Nantes, CRB, 9 quai Moncousu, 44093 Nantes Cedex 1, Nantes F-44093, France.
| | - Jean Harb
- Institut National de la Sante Et de la Recherche Médicale INSERM U1064, and Institut de Transplantation Urologie Néphrologie du Centre Hospitalier Universitaire Hôtel Dieu, LabEx Transplantex, CHU de Nantes, 30 Boulevard Jean Monnet, 44093 Nantes Cedex 01, France; Université de Nantes, Faculté de Médecine, Nantes, France.
| | - Sophie Brouard
- Institut National de la Sante Et de la Recherche Médicale INSERM U1064, and Institut de Transplantation Urologie Néphrologie du Centre Hospitalier Universitaire Hôtel Dieu, LabEx Transplantex, CHU de Nantes, 30 Boulevard Jean Monnet, 44093 Nantes Cedex 01, France; CIC Biothérapie, 5, allée de l'Ile Gloriette, 44093 Nantes Cedex 0144035, Nantes, France; CHU Nantes, CRB, 9 quai Moncousu, 44093 Nantes Cedex 1, Nantes F-44093, France.
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18
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Duhamel P, Suberbielle C, Grimbert P, Leclerc T, Jacquelinet C, Audry B, Bargues L, Charron D, Bey E, Lantieri L, Hivelin M. Anti-HLA sensitization in extensively burned patients: extent, associated factors, and reduction in potential access to vascularized composite allotransplantation. Transpl Int 2015; 28:582-93. [PMID: 25683513 DOI: 10.1111/tri.12540] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/03/2014] [Accepted: 02/06/2015] [Indexed: 12/21/2022]
Abstract
Extensively burned patients receive iterative blood transfusions and skin allografts that often lead to HLA sensitization, and potentially impede access to vascularized composite allotransplantation (VCA). In this retrospective, single-center study, anti-HLA sensitization was measured by single-antigen-flow bead analysis in patients with deep, second- and third-degree burns over ≥40% total body surface area (TBSA). Association of HLA sensitization with blood transfusions, skin allografts, and pregnancies was analyzed by bivariate analysis. The eligibility for transplantation was assessed using calculated panel reactive antibodies (cPRA). Twenty-nine patients aged 32 ± 14 years, including 11 women, presented with a mean burned TBSA of 54 ± 11%. Fifteen patients received skin allografts, comprising those who received cryopreserved (n = 3) or glycerol-preserved (n = 7) allografts, or both (n = 5). An average 36 ± 13 packed red blood cell (PRBC) units were transfused per patient. In sera samples collected 38 ± 13 months after the burns, all patients except one presented with anti-HLA antibodies, of which 13 patients (45%) had complement-fixing antibodies. Eighteen patients (62%) were considered highly sensitized (cPRA≥85%). Cryopreserved, but not glycerol-preserved skin allografts, history of pregnancy, and number of PRBC units were associated with HLA sensitization. Extensively burned patients may become highly HLA sensitized during acute care and hence not qualify for VCA. Alternatives to skin allografts might help preserve their later access to VCA.
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Affiliation(s)
- Patrick Duhamel
- Service de Chirurgie Plastique, Centre de Traitement des Brûlés, Hôpital d'Instruction des Armées Percy, Clamart Cedex, France
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19
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Djamali A, Kaufman DB, Ellis TM, Zhong W, Matas A, Samaniego M. Diagnosis and management of antibody-mediated rejection: current status and novel approaches. Am J Transplant 2014; 14:255-71. [PMID: 24401076 PMCID: PMC4285166 DOI: 10.1111/ajt.12589] [Citation(s) in RCA: 270] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 11/12/2013] [Indexed: 01/25/2023]
Abstract
Advances in multimodal immunotherapy have significantly reduced acute rejection rates and substantially improved 1-year graft survival following renal transplantation. However, long-term (10-year) survival rates have stagnated over the past decade. Recent studies indicate that antibody-mediated rejection (ABMR) is among the most important barriers to improving long-term outcomes. Improved understanding of the roles of acute and chronic ABMR has evolved in recent years following major progress in the technical ability to detect and quantify recipient anti-HLA antibody production. Additionally, new knowledge of the immunobiology of B cells and plasma cells that pertains to allograft rejection and tolerance has emerged. Still, questions regarding the classification of ABMR, the precision of diagnostic approaches, and the efficacy of various strategies for managing affected patients abound. This review article provides an overview of current thinking and research surrounding the pathophysiology and diagnosis of ABMR, ABMR-related outcomes, ABMR prevention and treatment, as well as possible future directions in treatment.
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Affiliation(s)
- A Djamali
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public HealthMadison, WI
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public HealthMadison, WI
| | - D B Kaufman
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public HealthMadison, WI
| | - T M Ellis
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public HealthMadison, WI
| | - W Zhong
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public HealthMadison, WI
- Pathology and Laboratory Services, William S. Middleton Memorial Veterans HospitalMadison, WI
| | - A Matas
- Division of Transplantation, Department of Surgery, University of MinnesotaMinneapolis, MN
| | - M Samaniego
- Division of Nephrology, Department of Medicine, University of MichiganAnn Arbor, MI
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20
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Guidicelli G, Anies G, Bachelet T, Dubois V, Moreau JF, Merville P, Couzi L, Taupin JL. The complement interference phenomenon as a cause for sharp fluctuations of serum anti-HLA antibody strength in kidney transplant patients. Transpl Immunol 2013; 29:17-21. [DOI: 10.1016/j.trim.2013.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/12/2013] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
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21
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Bachelet T, Couzi L, Lepreux S, Legeret M, Pariscoat G, Guidicelli G, Merville P, Taupin JL. Kidney intragraft donor-specific antibodies as determinant of antibody-mediated lesions and poor graft outcome. Am J Transplant 2013; 13:2855-64. [PMID: 24102857 DOI: 10.1111/ajt.12438] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/17/2013] [Accepted: 06/03/2013] [Indexed: 01/25/2023]
Abstract
Allograft pathology, antibody-tissue interaction as demonstrated by C4d deposition and serological evidence of donor-specific antibodies (DSA) are the cardinal diagnostic features of antibody-mediated lesions (AML) in kidney transplantation. However, discrepancy between histological and serological findings is common, and more reliable diagnostic tools are called for. Here, we asked whether the in situ detection of DSA could serve as marker for AML. To that end, we applied the anti-HLA single antigen flow bead assay to eluates from 51 needle core graft biopsies performed for cause. Intragraft antibody profiles were correlated to serum DSA (sDSA), histological data and transplant outcome. The prevalence and the mean number of intragraft DSA (gDSA) were lower than that of sDSA (15/51 gDSA+ vs. 37/51 sDSA+ patients; 1.64 gDSA vs. 2.24 sDSA per patient). DSA were detected in all anti-HLA antibody-positive biopsies (15/15). The presence of gDSA was significantly associated with (1) microcirculation lesions taken individually (g, cg) and analyzed in functional clusters (ptc + g + cg > 0, cg + mm > 0), (2) C4d positivity and (3) a worse short-term transplant outcome (p = 0.05). These associations were not found for patients presenting only sDSA. Taken together, these results indicate that gDSA is a severity marker of antibody-mediated pathogenic process.
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Affiliation(s)
- T Bachelet
- Department of Nephrology, Dialysis and Transplantation, CHU Bordeaux, Bordeaux, France; Laboratory of Immunology and Immunogenetics, CHU Bordeaux, Bordeaux, France; UMR 5164, CNRS and University Bordeaux Segalen, Bordeaux, France
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22
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Taber T, Mujtaba MA, Goggins W, Higgins N, Sharfuddin A, Yaqub MS, Mishler D, Book B, Chen J, Lobashevsky A. The effectiveness of the combination of rituximab and high-dose immunoglobulin in the immunomodulation of sensitized kidney transplant candidates. Clin Transplant 2013; 27:E375-82. [DOI: 10.1111/ctr.12142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Tim Taber
- Department of Medicine; Indiana University School of Medicine; Indianapolis; IN; USA
| | | | - William Goggins
- Department of Surgery; Indiana University School of Medicine; Indianapolis; IN; USA
| | - Nancy Higgins
- Department of Transplant Immunology Laboratory; Indiana University School of Medicine; Indianapolis; IN; USA
| | - Asif Sharfuddin
- Department of Medicine; Indiana University School of Medicine; Indianapolis; IN; USA
| | - Muhammad Sohail Yaqub
- Department of Medicine; Indiana University School of Medicine; Indianapolis; IN; USA
| | - Dennis Mishler
- Department of Medicine; Indiana University School of Medicine; Indianapolis; IN; USA
| | - Benita Book
- Department of Transplant Immunology Laboratory; Indiana University School of Medicine; Indianapolis; IN; USA
| | - Jeanne Chen
- Department of Pharmacy; Indiana University School of Medicine; Indianapolis; IN; USA
| | - Andrew Lobashevsky
- Department of Transplant Immunology Laboratory; Indiana University School of Medicine; Indianapolis; IN; USA
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23
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Morath C, Opelz G, Zeier M, Süsal C. Prevention of antibody-mediated kidney transplant rejection. Transpl Int 2012; 25:633-45. [PMID: 22587522 DOI: 10.1111/j.1432-2277.2012.01490.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
There is increasing evidence that antibody-mediated rejection is the major cause of late kidney graft failure. Prevention of antibody-mediated allograft damage has therefore become an important issue in kidney transplantation. Such prevention starts already before transplantation with the avoidance of sensitizing events. When a patient is already sensitized, precise characterization of alloantibodies and exact HLA typing of the donor at the time of transplantation are mandatory. To ensure timely and successful transplantation of highly sensitized patients, desensitization, and inclusion in special programs such as the Eurotransplant Acceptable Mismatch Program should be considered. After transplantation, close monitoring of kidney function, testing for the de novo development or changing characteristics of alloantibodies, and attention to non-adherence to immunosuppression is obligatory. In the current overview, we discuss the currently available measures for the prevention of antibody-mediated kidney graft rejection.
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Affiliation(s)
- Christian Morath
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
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24
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Charron D, Suberbielle-Boissel C, Tamouza R, Al-Daccak R. Anti-HLA antibodies in regenerative medicine stem cell therapy. Hum Immunol 2012; 73:1287-94. [PMID: 22789622 DOI: 10.1016/j.humimm.2012.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/14/2012] [Accepted: 06/29/2012] [Indexed: 01/14/2023]
Abstract
Research on stem cell therapies for regenerative medicine is progressing rapidly. Although the use of autologous stem cells is a tempting choice, there are several instances in which they are either defective or not available in due time. Allogenic stem cells derived from healthy donors presents a promising alternative. Whether autologous or allogenic, recent advances have proven that stem cells are not as immune privileged as they were thought. Therefore understanding the interactions of these cells with the recipient immune system is paramount to their clinical application. Transplantation of stem cells induces humoral as well as cellular immune response. This review focuses on the humoral response elicited by stem cells upon their administration and consequences on the survival and maintenance of the graft. Current transplantation identifies pre- and post-transplantation anti-HLA antibodies as immune rejection and cell signaling effectors. These two mechanisms are likely to operate similarly in the context of SC therapeutics. Ultimately this knowledge will help to propose novel strategies to mitigate the allogenic barriers. Immunogenetics selection of the donor cell and immunomonitoring are key factors to allow the implementation of regenerative stem cell in the clinics.
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Affiliation(s)
- Dominique Charron
- INSERM UMRS 940, Institut Universitaire d'Hématologie, Université Paris-Diderot and Laboratoire d'Immunologie et d'Histocompatibilité, Hôpital Saint Louis, CIB-HOG, AP-HP 1, Avenue Claude Vellefaux, 75010 Paris, France.
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25
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Hirai T, Kohei N, Omoto K, Ishida H, Tanabe K. Significance of low-level DSA detected by solid-phase assay in association with acute and chronic antibody-mediated rejection. Transpl Int 2012; 25:925-34. [DOI: 10.1111/j.1432-2277.2012.01518.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Huber L, Lachmann N, Dürr M, Matz M, Liefeldt L, Neumayer HH, Schönemann C, Budde K. Identification and Therapeutic Management of Highly Sensitized Patients Undergoing Renal Transplantation. Drugs 2012; 72:1335-54. [DOI: 10.2165/11631110-000000000-00000] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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27
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Otten HG, Verhaar MC, Borst HPE, Hené RJ, van Zuilen AD. Pretransplant donor-specific HLA class-I and -II antibodies are associated with an increased risk for kidney graft failure. Am J Transplant 2012; 12:1618-23. [PMID: 22404993 DOI: 10.1111/j.1600-6143.2011.03985.x] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Pretransplant risk assessment of graft failure is important for donor selection and choice of immunosuppressive treatment. We examined the relation between kidney graft failure and presence of IgG donor specific HLA antibodies (DSA) or C1q-fixing DSA, detected by single antigen bead array (SAB) in pretransplant sera from 837 transplantations. IgG-DSA were found in 290 (35%) sera, whereas only 30 (4%) sera had C1q-fixing DSA. Patients with both class-I plus -II DSA had a 10 yr graft survival of 30% versus 72% in patients without HLA antibodies (p < 0.001). No significant difference was observed in graft survival between patients with or without C1q-fixing DSA. Direct comparison of both assays showed that high mean fluorescence intensity values on the pan-IgG SAB assay are generally related to C1q-fixation. We conclude that the presence of class-I plus -II IgG DSA as detected by SAB in pretransplant sera of crossmatch negative kidney recipients is indicative for an increased risk for graft failure, whereas the clinical significance of C1q-fixing IgG-DSA could not be assessed due to their low prevalence.
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Affiliation(s)
- H G Otten
- Department of Immunology, University Medical Center Utrecht, The Netherlands.
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28
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Mengel M, Sis B, Haas M, Colvin RB, Halloran PF, Racusen LC, Solez K, Cendales L, Demetris AJ, Drachenberg CB, Farver CF, Rodriguez ER, Wallace WD, Glotz D. Banff 2011 Meeting report: new concepts in antibody-mediated rejection. Am J Transplant 2012; 12:563-70. [PMID: 22300494 PMCID: PMC3728651 DOI: 10.1111/j.1600-6143.2011.03926.x] [Citation(s) in RCA: 318] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The 11th Banff meeting was held in Paris, France, from June 5 to 10, 2011, with a focus on refining diagnostic criteria for antibody-mediated rejection (ABMR). The major outcome was the acknowledgment of C4d-negative ABMR in kidney transplants. Diagnostic criteria for ABMR have also been revisited in other types of transplants. It was recognized that ABMR is associated with heterogeneous phenotypes even within the same type of transplant. This highlights the necessity of further refining the respective diagnostic criteria, and is of particular significance for the design of randomized clinical trials. A reliable phenotyping will allow for definition of robust end-points. To address this unmet need and to allow for an evidence-based refinement of the Banff classification, Banff Working Groups presented multicenter data regarding the reproducibility of features relevant to the diagnosis of ABMR. However, the consensus was that more data are necessary and further Banff Working Group activities were initiated. A new Banff working group was created to define diagnostic criteria for ABMR in kidneys independent of C4d. Results are expected to be presented at the 12th Banff meeting to be held in 2013 in Brazil. No change to the Banff classification occurred in 2011.
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Affiliation(s)
- M. Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada,Department of Medicine, Alberta Transplant Applied Genomics Centre, Division of Nephrology & Immunology, University of Alberta, Edmonton, Canada,Corresponding author: Michael Mengel,
| | - B. Sis
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada,Department of Medicine, Alberta Transplant Applied Genomics Centre, Division of Nephrology & Immunology, University of Alberta, Edmonton, Canada
| | - M. Haas
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - R. B. Colvin
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | - P. F. Halloran
- Department of Medicine, Alberta Transplant Applied Genomics Centre, Division of Nephrology & Immunology, University of Alberta, Edmonton, Canada
| | - L. C. Racusen
- Department of Pathology, Johns Hopkins University, Baltimore, MD
| | - K. Solez
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - L. Cendales
- Emory Transplant Center, Emory University School of Medicine and Atlanta Veterans Affairs Medical Center, Atlanta, GA
| | - A. J. Demetris
- Division of Transplantation Pathology, Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | | | - C. F. Farver
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH
| | - E. R. Rodriguez
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH
| | - W. D. Wallace
- Department of Laboratory Medicine and Pathology, University of California, Los Angeles, CA
| | - D. Glotz
- Department of Nephrology, Hospital Saint-Louis, Paris, France
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29
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Morath C, Beimler J, Opelz G, Scherer S, Schmidt J, Macher-Goeppinger S, Klein K, Sommerer C, Schwenger V, Zeier M, Süsal C. Living donor kidney transplantation in crossmatch-positive patients enabled by peritransplant immunoadsorption and anti-CD20 therapy. Transpl Int 2012; 25:506-17. [PMID: 22372718 DOI: 10.1111/j.1432-2277.2012.01447.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Living donor kidney transplantation in crossmatch-positive patients is a challenge that requires specific measures. Ten patients with positive crossmatch results (n = 9) or negative crossmatch results but strong donor-specific antibodies (DSA; n = 1) were desensitized using immunoadsorption (IA) and anti-CD20 antibody induction. IA was continued after transplantation and accompanied by HLA antibody monitoring and protocol biopsies. After a median of 10 IA treatments, all patients were desensitized successfully and transplanted. Median levels of mean fluorescence intensity (MFI) of Luminex-DSA before desensitization were 6203 and decreased after desensitization and immediately before transplantation to 891. Patients received a median of seven post-transplant IA treatments. At last visit, after a median follow-up of 19 months, 9 of 10 patients had a functioning allograft and a median Luminex-DSA of 149 MFI; serum creatinine was 1.6 mg/dl, and protein to creatinine ratio 0.1. Reversible acute antibody-mediated rejection was diagnosed in three patients. One allograft was lost after the second post-transplant year in a patient with catastrophic antiphospholipid syndrome. We describe a treatment algorithm for desensitization of living donor kidney transplant recipients that allows the rapid elimination of DSA with a low rate of side effects and results in good graft outcome.
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Affiliation(s)
- Christian Morath
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
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30
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Kohei N, Hirai T, Omoto K, Ishida H, Tanabe K. Chronic antibody-mediated rejection is reduced by targeting B-cell immunity during an introductory period. Am J Transplant 2012; 12:469-76. [PMID: 22054413 DOI: 10.1111/j.1600-6143.2011.03830.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Transplantation across blood group antigen and human leukocyte antigen (HLA) barriers are immunologically high risk. Both splenectomy and rituximab injection were developed to overcome those immunological barriers. The idea behind these treatments is to control B-cell immunity before and after renal transplantation and antibody production. Between January 2001 and December 2004, recipients underwent pretransplant double-filtration plasmapheresis (DFPP) and splenectomy at the time of transplantation in the ABO-incompatible group (ABO-I-SPX; n= 45). From January 2005 to June 2009, a low dose of rituximab was given as an alternative to splenectomy (ABO-I-RIT; n = 57). As a control group, we selected 83 cases of ABO-C living-donor kidney transplantation between January 2001 and December 2007 (ABO-C). We compared the graft survival rate and chronic antibody-mediated rejection (C-AMR) rate between ABO-C and ABO-I kidney transplantation with induction treatment. C-AMR rates 2 years after the operation were 8.8, 3.5 and 28.9%, and de novo donor-specific anti-HLA antibody (DSHA) positive rates were 2.2, 1.7 and 18.1% in the ABO-I-SPX, ABO-I-RIT and ABO-C groups, respectively. The ABO-C group showed the highest rate of C-AMR and de novo DSHA. B-cell depletion protocols, such as splenectomy or rituximab administration, reduced C-AMR after kidney transplantation.
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Affiliation(s)
- N Kohei
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
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