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Baranwal AK, Agarwal SK, Mehra N. MHC Class I Related Chain A (MICA) Antibodies - A Potential Cause of Renal Allograft Rejection. Indian J Nephrol 2021; 31:583-586. [PMID: 35068770 PMCID: PMC8722556 DOI: 10.4103/ijn.ijn_407_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: 08/18/2020] [Accepted: 10/25/2020] [Indexed: 11/09/2022] Open
Abstract
MHC class I related chain A (MICA) antibodies, especially those directed against the donor in absence of donor-specific anti-HLA antibodies have been reported to be possibly associated with renal allograft rejection in sensitized recipients. We are the first ones to present a case series of five patients who underwent primary live related donor renal transplantation in non-sensitized recipients either in the presence of donor-specific MICA antibodies (MICA-DSA) or developed de novo. Four of them presented characteristics of either accelerated, acute or chronic antibody-mediated rejection (AMR) attributable to the presence of MICA DSA. This case series emphasizes that AMR due to MICA-DSA is amenable to treatment with conventional regimens for treatment of AMR and there is a need for screening of MICA antibodies especially those directed against the donor on case to case basis.
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Affiliation(s)
- Ajay Kumar Baranwal
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, Pune, Maharashtra, India.,Department of Pathology, Command Hospital, Pune, Maharashtra, India
| | - Sanjay Kumar Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Narinder Mehra
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, Pune, Maharashtra, India.,National Chair, ICMR, New Delhi, India
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2
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Tambur AR, Kosmoliaptsis V, Claas FHJ, Mannon RB, Nickerson P, Naesens M. Significance of HLA-DQ in kidney transplantation: time to reevaluate human leukocyte antigen matching priorities to improve transplant outcomes? An expert review and recommendations. Kidney Int 2021; 100:1012-1022. [PMID: 34246656 DOI: 10.1016/j.kint.2021.06.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 12/14/2022]
Abstract
The weight of human leukocyte antigen (HLA) matching in kidney allocation algorithms, especially in the United States, has been devalued in a stepwise manner, supported by the introduction of modern immunosuppression. The intent was further to reduce the observed ethnic/racial disparity, as data emerged associating HLA matching with decreased access to transplantation for African American patients. In recent years, it has been increasingly recognized that a leading cause of graft loss is chronic antibody-mediated rejection, attributed to the development of de novo antibodies against mismatched donor HLA expressed on the graft. These antibodies are most frequently against donor HLA-DQ molecules. Beyond their impact on graft survival, generation of de novo donor-specific HLA antibodies also leads to increased sensitization, as measured by panel-reactive antibody metrics. Consequently, access to transplantation for patients returning to the waitlist in need of a second transplant is compromised. Herein, we address the implications of reduced HLA matching policies in kidney allocation. We highlight the observed diminished outcome data, the significant financial burden, the long-term health consequences, and, more important, the unintended consequences. We further provide recommendations to examine the impact of donor-recipient HLA class II and specifically HLA-DQα1β1 mismatching, focusing on collection of appropriate data, application of creative simulation approaches, and reconsideration of best practices to reduce inequalities while optimizing patient outcomes.
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Affiliation(s)
- Anat R Tambur
- Comprehensive Transplant Center, Northwestern University, Chicago, Illinois, USA.
| | - Vasilis Kosmoliaptsis
- Department of Surgery, University of Cambridge, Cambridge, UK; NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation and NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Frans H J Claas
- Department of Immunology, Leiden University Medical Center, Leiden, the Netherlands
| | - Roslyn B Mannon
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Peter Nickerson
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maarten Naesens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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3
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Baranwal AK, Bhat DK, Goswami S, Agarwal SK, Kaur G, Mehra N. Clinical relevance of major histocompatibility complex class I chain-related molecule A (MICA) antibodies in live donor renal transplantation - Indian Experience. Scand J Immunol 2020; 92:e12923. [PMID: 32593197 DOI: 10.1111/sji.12923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/29/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Abstract
Antibody-mediated rejections (AMR) in the absence of circulating anti-HLA-DSA have highlighted the role of non-HLA antibodies, particularly those directed against endothelial cells. Of these, MICA (major histocompatibility complex class I chain-related molecule A) antibodies are the most notable and important because of their potential in promoting graft rejections. Limited studies have focused on the impact of MICA donor-specific antibodies (DSA) on graft outcome as compared to those that are not donor-specific (NDSA). We evaluated pre- and post-transplant sera at POD 7, 30, 90, 180 and the time of biopsy from 206 consecutive primary live donor renal transplant recipients for anti-MICA and anti-HLA antibodies using single antigen bead assay on a Luminex platform. Recipients who developed MICA antibodies and their donors were phenotyped for MICA alleles. For the purpose of antibody analysis, patients were categorized into three major groups: biopsy-proven AMR, acute cellular rejection (ACR) and those with no rejection episodes (NRE). During the mean follow-up period of 17.37 ± 6.88 months, 16 of the 206 recipients developed AMR, while ACR was observed in only 13 cases. A quarter (25%) of the AMR cases had anti-MICA antibodies as compared to 7.7% of those experiencing ACR and 6.2% of the NRE group. Allelic typing revealed that all MICA Ab +ve AMR cases were due to the presence of donor-specific antibodies. MICA-DSA even in the absence of HLA-DSA was significantly associated with AMR but not with ACR when compared with the NRE group (P = <.01).
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Affiliation(s)
- Ajay Kumar Baranwal
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India.,Department of Pathology, Command Hospital, Pune, India
| | - Deepali K Bhat
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India.,Cellular & Molecular Therapeutic Branch, NHLBI, National Institute of Health (NIH), Bethesda, MD, USA
| | - Sanjeev Goswami
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Kumar Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Gurvinder Kaur
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India.,Laboratory Oncology, Dr BR Ambedkar Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Narinder Mehra
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India.,National Chair, All India Institute of Medical Sciences, New Delhi, India
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4
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Laguna-Goya R, Suàrez-Fernández P, Paz-Artal E. Follicular helper T cells and humoral response in organ transplantation. Transplant Rev (Orlando) 2019; 33:183-190. [PMID: 31327572 DOI: 10.1016/j.trre.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/17/2019] [Accepted: 06/28/2019] [Indexed: 02/07/2023]
Abstract
Antibody mediated rejection has been recognized as an important contributor to long-term graft loss in most solid organ transplants. Current immunosuppressive regimes are not capable of preventing anti-HLA antibody formation and eventual damage to the graft, and there is a need to develop drugs directed against novel targets to avoid graft allorecognition. In this review we introduce follicular helper T cells (Tfh), a subtype of lymphocyte specialized in helping B cells to differentiate into plasmablasts and produce class-switched antibodies. We focus on the role of Tfh in solid organ transplantation, what is known about Tfh and the production of alloantibodies, how current immunosuppressive therapies affect Tfh and what new molecules could be used to target Tfh in transplantation, with the goal of improving graft survival.
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Affiliation(s)
- R Laguna-Goya
- Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de investigación Hospital Universitario 12 de Octubre (Imas12), Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain.
| | - P Suàrez-Fernández
- Instituto de investigación Hospital Universitario 12 de Octubre (Imas12), Madrid, Spain
| | - E Paz-Artal
- Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de investigación Hospital Universitario 12 de Octubre (Imas12), Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain
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5
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Cano-Romero FL, Laguna Goya R, Utrero-Rico A, Gómez-Massa E, Arroyo-Sánchez D, Suárez-Fernández P, Lora D, Andrés A, Castro-Panete MJ, Paz-Artal E. Longitudinal profile of circulating T follicular helper lymphocytes parallels anti-HLA sensitization in renal transplant recipients. Am J Transplant 2019; 19:89-97. [PMID: 29947147 DOI: 10.1111/ajt.14987] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/27/2018] [Accepted: 06/19/2018] [Indexed: 01/25/2023]
Abstract
Antibody-mediated rejection is responsible for 30%-50% of renal graft failures. Differentiation of B cells into antibody-producing plasmablasts depends on the collaboration of follicular helper T cells (Tfh). We analyzed circulating Tfh (cTfh) in kidney recipients and studied cTfh relationship with anti-HLA antibody production and graft outcome. cTfh were longitudinally analyzed in a prospective cohort of patients (n = 206), pre- and posttransplantation. Clinical data, HLA sensitization, and cTfh function were recorded. Both pretransplant and 6-month posttransplant cTfh were able to derive IgG-producing plasmablasts. Pretransplant cTfh was decreased in patients, especially in those who received dialysis. However, these cells were increased in patients with previous allograft or transfusions and in HLA-sensitized recipients. After transplantation cTfh expanded, significantly more in patients who developed de novo anti-HLA antibodies than in patients who remained unsensitized. Augmented pretransplant cTfh positively correlated with higher intensity of pretransplant anti-HLA class I and with de novo anti-HLA class I and anti-HLA class II antibodies. Consistently, pretransplantation cTfh were higher in patients who experienced acute rejection (HR = 1.14 [1.04-1.25]). Thus, we show a role for Tfh in anti-HLA sensitization and rejection. Multicenter studies with additional patient cohorts are needed to validate these results. Immunosuppressive drugs targeting Tfh could be useful to improve outcomes.
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Affiliation(s)
- Francisco Luis Cano-Romero
- Department of Immunology, Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Rocío Laguna Goya
- Department of Immunology, Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Department of Immunology, Universidad Complutense de Madrid, Madrid, Spain.,Department of Pharmaceutical Sciences, Universidad San Pablo CEU, Madrid, Spain
| | - Alberto Utrero-Rico
- Department of Immunology, Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Elena Gómez-Massa
- Department of Immunology, Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Daniel Arroyo-Sánchez
- Department of Immunology, Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Patricia Suárez-Fernández
- Department of Immunology, Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - David Lora
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Amado Andrés
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | - Mª José Castro-Panete
- Department of Immunology, Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Estela Paz-Artal
- Department of Immunology, Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Department of Immunology, Universidad Complutense de Madrid, Madrid, Spain.,Department of Pharmaceutical Sciences, Universidad San Pablo CEU, Madrid, Spain
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6
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Mallon DH, Kling C, Robb M, Ellinghaus E, Bradley JA, Taylor CJ, Kabelitz D, Kosmoliaptsis V. Predicting Humoral Alloimmunity from Differences in Donor and Recipient HLA Surface Electrostatic Potential. THE JOURNAL OF IMMUNOLOGY 2018; 201:3780-3792. [PMID: 30429288 PMCID: PMC6287104 DOI: 10.4049/jimmunol.1800683] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/02/2018] [Indexed: 11/27/2022]
Abstract
In transplantation, development of humoral alloimmunity against donor HLA is a major cause of organ transplant failure, but our ability to assess the immunological risk associated with a potential donor–recipient HLA combination is limited. We hypothesized that the capacity of donor HLA to induce a specific alloantibody response depends on their structural and physicochemical dissimilarity compared with recipient HLA. To test this hypothesis, we first developed a novel computational scoring system that enables quantitative assessment of surface electrostatic potential differences between donor and recipient HLA molecules at the tertiary structure level [three-dimensional electrostatic mismatch score (EMS-3D)]. We then examined humoral alloimmune responses in healthy females subjected to a standardized injection of donor lymphocytes from their male partner. This analysis showed a strong association between the EMS-3D of donor HLA and donor-specific alloantibody development; this relationship was strongest for HLA-DQ alloantigens. In the clinical transplantation setting, the immunogenic potential of HLA-DRB1 and -DQ mismatches expressed on donor kidneys, as assessed by their EMS-3D, was an independent predictor of development of donor-specific alloantibody after graft failure. Collectively, these findings demonstrate the translational potential of our approach to improve immunological risk assessment and to decrease the burden of humoral alloimmunity in organ transplantation.
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Affiliation(s)
- Dermot H Mallon
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.,National Institute for Health Research Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge CB2 0QQ, United Kingdom.,National Institute of Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, United Kingdom
| | - Christiane Kling
- Institute for Immunology, University Medical Centre Schleswig-Holstein, Kiel University, 24105 Kiel, Germany
| | - Matthew Robb
- Statistics and Clinical Studies Unit, National Health Service Blood and Transplant, Bristol BS34 7QH, United Kingdom
| | - Eva Ellinghaus
- Institute of Clinical Molecular Biology, University Medical Centre Schleswig-Holstein, Kiel University, 24105 Kiel, Germany; and
| | - J Andrew Bradley
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.,National Institute for Health Research Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge CB2 0QQ, United Kingdom.,National Institute of Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, United Kingdom
| | - Craig J Taylor
- National Institute of Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, United Kingdom.,Tissue Typing Laboratory, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Dieter Kabelitz
- Institute for Immunology, University Medical Centre Schleswig-Holstein, Kiel University, 24105 Kiel, Germany
| | - Vasilis Kosmoliaptsis
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; .,National Institute for Health Research Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge CB2 0QQ, United Kingdom.,National Institute of Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, United Kingdom
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7
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Baranwal AK, Bhat DK, Goswami S, Agarwal SK, Kaur G, Kaur J, Mehra N. Comparative analysis of Luminex-based donor-specific antibody mean fluorescence intensity values with complement-dependent cytotoxicity & flow crossmatch results in live donor renal transplantation. Indian J Med Res 2017. [PMID: 28639599 PMCID: PMC5501055 DOI: 10.4103/ijmr.ijmr_222_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background & objectives: Antibodies specific to donor human leucocyte antigen (HLA) play a critical role in graft rejection and graft loss. In recent years, techniques for their detection have evolved significantly providing an ever-increasing degree of sensitivity and specificity, from the conventional cell-based assays to the advanced solid-phase system based on the Luminex platform. Consensus is still evolving on the routine employment of all these methods, either stand alone or in combination. The objective of this study was to explore the near-accurate mean fluorescence intensity (MFI) cut-off values detected on Luminex platform predicting the strength of cell-based crossmatch results. Methods: Serum samples from 116 primary renal transplant recipients awaiting transplantation were tested for the presence of antidonor antibodies by the complement-dependent cytotoxicity (CDC) and flow crossmatch (FCXM) methods with their corresponding donors as well as for HLA-donor-specific antibodies (DSA) detection using a sensitive single antigen bead (SAB) assay. Results: None of the patients having HLA Class I DSA with MFI values <1000 showed positivity for T-cell FCXM or CDC crossmatch, while in the group having MFI values between 1000 and 3000, 54 per cent showed positivity for the FCXM but none by the CDC method. However, in the group having MFI values >3000, 95 per cent of cases were positive for FCXM. Further, those groups with MFI values between 3000 and 5000, only 36 per cent were positive for CDC crossmatch, while 90 per cent showed positivity in the group with MFI >7000. Interpretation & conclusions: A cut-off MFI value of 3000 for Luminex SAB-based assay was found to significantly correlate with the FCXM positivity while a MFI value of 7000 and above predicted a positive CDC crossmatch. MFI cut-off value obtained as a surrogate marker for CDC and FCXM tests will help in resolving the limitations of different cell-based techniques.
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Affiliation(s)
- Ajay Kumar Baranwal
- Department of Transplant Immunology & Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Krishan Bhat
- Department of Transplant Immunology & Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Goswami
- Department of Transplant Immunology & Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Kumar Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi,, India
| | - Gurvinder Kaur
- Department of Transplant Immunology & Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Jasmeet Kaur
- Department of Pathology, Army Hospital R & R, New Delhi, India
| | - Narinder Mehra
- Department of Transplant Immunology & Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
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8
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IgM-Enriched Human Intravenous Immunoglobulin-Based Treatment of Patients With Early Donor Specific Anti-HLA Antibodies After Lung Transplantation. Transplantation 2017; 100:2682-2692. [PMID: 26714123 PMCID: PMC5120772 DOI: 10.1097/tp.0000000000001027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND At our institution, until April 2013, patients who showed early donor specific anti-HLA antibodies (DSA) after lung transplantation were preemptively treated with therapeutic plasma exchange (tPE) and a single dose of Rituximab. In April 2013, we moved to a therapy based on IgM-enriched human immunoglobulins (IVIG), repeated every 4 weeks, and a single dose of Rituximab. METHODS This observational study was designed to evaluate the short-term patient and graft survival in patients who underwent IVIG-based DSA treatment (group A, n = 57) versus contemporary patients transplanted between April 2013 and January 2015 without DSA (group C, n = 180), as well as to evaluate DSA clearance in IVIG-treated patients versus historic patients who had undergone tPE-based treatment (group B, n = 56). Patient records were retrospectively reviewed. Follow-up ended on April 1, 2015. RESULTS At 6 months and 1 year of follow-up, group A had a survival similar to group C (P = 0.81) but better than group B (P = 0.008). Group A showed statistically nonsignificant trends toward improved freedom from pulsed-steroid therapy and biopsy-confirmed rejection over groups B and C. The DSA clearance was better in group A than group B at treatment end (92% vs 64%; P = 0.002) and last DSA control (90% vs 75%; P = 0.04). CONCLUSIONS Patients with new early DSA but without graft dysfunction that are treated with IVIG and Rituximab have similarly good early survival as contemporary lung transplant recipients without early DSA. The IVIG yielded increased DSA clearance compared with historic tPE-based treatment, yet spontaneous clearance of new DSA also remains common.
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9
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Baranwal AK, Mehra NK. Major Histocompatibility Complex Class I Chain-Related A (MICA) Molecules: Relevance in Solid Organ Transplantation. Front Immunol 2017; 8:182. [PMID: 28293239 PMCID: PMC5329007 DOI: 10.3389/fimmu.2017.00182] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 02/08/2017] [Indexed: 11/27/2022] Open
Abstract
An ever growing number of reports on graft rejection and/or failure even with good HLA matches have highlighted an important role of non-HLA antigens in influencing allograft immunity. The list of non-HLA antigens that have been implicated in graft rejection in different types of organ transplantation has already grown long. Of these, the Major Histocompatibility Complex class I chain-related molecule A (MICA) is one of the most polymorphic and extensively studied non-HLA antigenic targets especially in the kidney transplantation. Humoral response to MICA antigens has repeatedly been associated with lower graft survival and an increased risk of acute and chronic rejection following kidney and liver transplantation with few studies showing conflicting results. Although there are clear indications of MICA antibodies being associated with adverse graft outcome, a definitive consensus on this relationship has not been arrived yet. Furthermore, only a few studies have dealt with the impact of MICA donor-specific antibodies as compared to those that are not donor specific on graft outcome. In addition to the membrane bound form, a soluble isoform of MICA (sMICA), which has the potential to engage the natural killer cell-activating receptor NKG2D resulting in endocytosis and degradation of receptor–ligand interaction complex leading to suppression of NKG2D-mediated host innate immunity, has been a subject of intense discussion. Most studies on sMICA have been directed toward understanding their influence on tumor growth, with limited literature focusing its role in transplant biology. Furthermore, a unique dimorphism (methionine to valine) at position 129 in the α2 domain categorizes MICA alleles into strong (MICA-129 met) and weak (MICA-129 val) binders of NKG2D receptor depending on whether they have methionine or valine at this position. Although the implications of MICA 129 dimorphism have been highlighted in hematopoietic stem cell transplantation, its role in solid organ transplantation is yet to be explored. This review summarizes the currently available information on MICA antibodies, soluble MICA, and MICA-129 dimorphism in a setting of solid organ transplantation.
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Affiliation(s)
| | - Narinder K Mehra
- All India Institute of Medical Sciences , New Delhi, Delhi , India
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10
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Mehra NK, Baranwal AK. Clinical and immunological relevance of antibodies in solid organ transplantation. Int J Immunogenet 2016; 43:351-368. [DOI: 10.1111/iji.12294] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/10/2016] [Accepted: 10/16/2016] [Indexed: 12/22/2022]
Affiliation(s)
- N. K. Mehra
- National Chair and Former Dean (Research); All India Institute of Medical Sciences; New Delhi India
| | - A. K. Baranwal
- Department of Transplant Immunology and Immunogenetics; All India Institute of Medical Sciences; New Delhi India
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11
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Uptake of HLA Alloantigens via CD89 and CD206 Does Not Enhance Antigen Presentation by Indirect Allorecognition. J Immunol Res 2016; 2016:4215684. [PMID: 27413760 PMCID: PMC4931073 DOI: 10.1155/2016/4215684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 05/01/2016] [Accepted: 05/16/2016] [Indexed: 11/17/2022] Open
Abstract
In organ transplantation, alloantigens are taken up by antigen presenting cells and presented via the indirect pathway to T-cells which in turn can induce allograft rejection. Monitoring of these T-cells is of major importance; however no reliable assay is available to routinely monitor indirect allorecognition. Recently we showed that HLA monomers can be successfully used to monitor indirect allorecognition. Targeting antigens to endocytic receptors on antigen presenting cells may further enhance the presentation of antigens via HLA class II and improve the efficiency of this assay. In the current study we explored targeting of HLA monomers to either CD89 expressing monocytes or mannose receptor expressing dendritic cells. Monomer-antibody complexes were generated using biotin-labeled monomers and avidin labeling of the antibodies. We demonstrate that targeting the complexes to these receptors resulted in a dose-dependent HLA class II mediated presentation to a T-cell clone. The immune-complexes were efficiently taken up and presented to T-cells. However, the level of T-cell reactivity was similar to that when only exogenous antigen was added. We conclude that HLA-A2 monomers targeted for presentation through CD89 on monocytes or mannose receptor on dendritic cells lead to proper antigen presentation but do not enhance indirect allorecognition via HLA-DR.
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12
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Kosmoliaptsis V, Mallon DH, Chen Y, Bolton EM, Bradley JA, Taylor CJ. Alloantibody Responses After Renal Transplant Failure Can Be Better Predicted by Donor-Recipient HLA Amino Acid Sequence and Physicochemical Disparities Than Conventional HLA Matching. Am J Transplant 2016; 16:2139-47. [PMID: 26755448 PMCID: PMC5021128 DOI: 10.1111/ajt.13707] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/08/2015] [Accepted: 12/27/2015] [Indexed: 01/25/2023]
Abstract
We have assessed whether HLA immunogenicity as defined by differences in donor-recipient HLA amino-acid sequence (amino-acid mismatch score, AMS; and eplet mismatch score, EpMS) and physicochemical properties (electrostatic mismatch score, EMS) enables prediction of allosensitization to HLA, and also prediction of the risk of an individual donor-recipient HLA mismatch to induce donor-specific antibody (DSA). HLA antibody screening was undertaken using single-antigen beads in 131 kidney transplant recipients returning to the transplant waiting list following first graft failure. The effect of AMS, EpMS, and EMS on the development of allosensitization (calculated reaction frequency [cRF]) and DSA was determined. Multivariate analyses, adjusting for time on the waiting list, maintenance on immunosuppression after transplant failure, and graft nephrectomy, showed that AMS (odds ratio [OR]: 1.44 per 10 units, 95% CI: 1.02-2.10, p = 0.04) and EMS (OR: 1.27 per 10 units, 95% CI: 1.02-1.62, p = 0.04) were independently associated with the risk of developing sensitization to HLA (cRF > 15%). AMS, EpMS, and EMS were independently associated with the development of HLA-DR and HLA-DQ DSA, but only EMS correlated with the risk of HLA-A and -B DSA development. Differences in donor-recipient HLA amino-acid sequence and physicochemical properties enable better assessment of the risk of HLA-specific sensitization than conventional HLA matching.
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Affiliation(s)
| | - D. H. Mallon
- Department of SurgeryUniversity of CambridgeCambridgeUK
| | - Y. Chen
- Statistical LaboratoryCentre for Mathematical SciencesUniversity of CambridgeCambridgeUK
| | - E. M. Bolton
- Department of SurgeryUniversity of CambridgeCambridgeUK
| | - J. A. Bradley
- Department of SurgeryUniversity of CambridgeCambridgeUK
| | - C. J. Taylor
- Tissue Typing LaboratoryCambridge University HospitalsCambridgeUK
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Takamura T, Yamamoto I, Nakada Y, Katsumata H, Yamakawa T, Furuya M, Mafune A, Kobayashi A, Tanno Y, Miki J, Ohkido I, Tsuboi N, Yamamoto H, Yokoo T. Acute T cell-mediated rejection accompanied by C4d-negative acute antibody-mediated rejection and cell debris in tubulus: A case report. Nephrology (Carlton) 2015; 20 Suppl 2:70-4. [DOI: 10.1111/nep.12466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2015] [Indexed: 01/06/2023]
Affiliation(s)
- Tsuyoshi Takamura
- Division of Nephrology and Hypertension, Department of Internal Medicine; The Jikei University School of Medicine; Tokyo Japan
| | - Izumi Yamamoto
- Division of Nephrology and Hypertension, Department of Internal Medicine; The Jikei University School of Medicine; Tokyo Japan
| | - Yasuyuki Nakada
- Division of Nephrology and Hypertension, Department of Internal Medicine; The Jikei University School of Medicine; Tokyo Japan
| | - Haruki Katsumata
- Division of Nephrology and Hypertension, Department of Internal Medicine; The Jikei University School of Medicine; Tokyo Japan
| | - Takafumi Yamakawa
- Division of Nephrology and Hypertension, Department of Internal Medicine; The Jikei University School of Medicine; Tokyo Japan
| | - Maiko Furuya
- Division of Nephrology and Hypertension, Department of Internal Medicine; The Jikei University School of Medicine; Tokyo Japan
| | - Aki Mafune
- Division of Nephrology and Hypertension, Department of Internal Medicine; The Jikei University School of Medicine; Tokyo Japan
| | - Akimitsu Kobayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine; The Jikei University School of Medicine; Tokyo Japan
| | - Yudo Tanno
- Division of Nephrology and Hypertension, Department of Internal Medicine; The Jikei University School of Medicine; Tokyo Japan
| | - Jun Miki
- Department of Urology; The Jikei University School of Medicine; Tokyo Japan
| | - Ichiro Ohkido
- Division of Nephrology and Hypertension, Department of Internal Medicine; The Jikei University School of Medicine; Tokyo Japan
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine; The Jikei University School of Medicine; Tokyo Japan
| | - Hiroyasu Yamamoto
- Department of Internal Medicine; Atsugi City Hospital; Kanagawa Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine; The Jikei University School of Medicine; Tokyo Japan
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14
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Pirim I, Soyoz M, Ayna TK, Kocyigit AO, Gurbuz BC, Tugmen C, Kurtulmus Y, Ozyilmaz B. De Novo Produced Anti-Human Leukocyte Antigen Antibodies Relation to Alloimmunity in Patients with Chronic Renal Failure. Genet Test Mol Biomarkers 2015; 19:335-8. [DOI: 10.1089/gtmb.2014.0294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Ibrahim Pirim
- Department of Medical Biology and Genetics, Izmir Katip Celebi University, Izmir, Turkey
- Tissue Typing Laboratory, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mustafa Soyoz
- Department of Medical Biology and Genetics, Izmir Katip Celebi University, Izmir, Turkey
- Tissue Typing Laboratory, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Tulay K. Ayna
- Department of Medical Biology and Genetics, Izmir Katip Celebi University, Izmir, Turkey
- Tissue Typing Laboratory, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Asli O. Kocyigit
- Department of Medical Biology and Genetics, Izmir Katip Celebi University, Izmir, Turkey
- Tissue Typing Laboratory, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Burcu C. Gurbuz
- Department of Medical Biology and Genetics, Izmir Katip Celebi University, Izmir, Turkey
- Tissue Typing Laboratory, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Cem Tugmen
- General Surgery Department, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Yusuf Kurtulmus
- Tissue Typing Laboratory, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Berk Ozyilmaz
- Tissue Typing Laboratory, Tepecik Training and Research Hospital, Izmir, Turkey
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15
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Structural and electrostatic analysis of HLA B-cell epitopes: inference on immunogenicity and prediction of humoral alloresponses. Curr Opin Organ Transplant 2015; 19:420-7. [PMID: 24977436 DOI: 10.1097/mot.0000000000000108] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW The immunogenic capacity of donor human leukocyte antigen (HLA) to induce humoral immune responses is not an intrinsic property of the mismatched alloantigen but depends on the HLA phenotype of the recipient. In recent years, advances in molecular sequence technology and information from X-ray crystallography have enabled structural comparison of donor and recipient HLA type providing an opportunity for a more rational approach for determining HLA compatibility. In this article, we review studies investigating the molecular basis of antibody-antigen interactions and present computational approaches to determine the complex physiochemical and structural properties of B-cell epitopes. RECENT FINDINGS The relative immunogenicity of individual HLA mismatches may be predicted from analysis of polymorphic amino acids at continuous and discontinuous HLA sequence positions. The use of alloantigen sequence information alone, however, provides limited insight into key determinants of B-cell epitope immunogenicity, such as the orientation, accessibility and physiochemical properties of amino acid side chains. Advances in computational molecular modelling techniques now enable assessment of HLA-alloantibody interactions at the atomic level. Recent evidence supports a strong link between HLA B-cell epitope surface electrostatic potential and their immunogenicity. SUMMARY Assessment of the surface electrostatic properties of HLA alloantigens and computational analyses of HLA-alloantibody interactions represent a promising area for future research into the molecular basis of HLA immunogenicity and antigenicity.
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16
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Nowosiad-Magda M, Myślak M, Roszkowska P, Borowiec-Chłopek Z, Urasińska E, Różański J, Domański L, Ciechanowski K, Giedrys-Kalemba S. Analysis of specificity of anti-human leukocyte antigen antibodies in kidney recipients in reference to clinical outcome. Transplant Proc 2014; 46:2606-12. [PMID: 25380877 DOI: 10.1016/j.transproceed.2014.09.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Anti-human leukocyte antigens antibodies (HLA) are not always the main cause of graft injury but can be a marker of immune response to the graft. The aim of this study was to analyze anti-HLA specificities with the use of the most sensitive detection method (Luminex) in reference to clinical condition. METHODS Sera of 65 kidney recipients (n = 443) were screened with the use of the mixed LABScreen kit, and, for 47 recipients, sera with maximal normalized background ratio (NBG) were subjected to specificity testing. NBG, numbers of specificities, donor-specific antibodies (DSA), and normalized mean fluorescence index (nMFI) of DSA and maximal anti-HLA were analyzed in reference to clinical (acute rejection [AR] diagnosis, immunosuppression), histopathological (C4d staining, chronic allograft nephropathy, AR type), and laboratory parameters (creatinine). RESULTS We observed 1 to 51 specificities, class I DSA in 26.7%, class II in 10%, and estimated DQ-DSA in 63.3% of tested patients. Patients with AR and humoral AR had significantly higher NBG, number of anti-HLA class I, DQ and DQ-DSA types, and more frequently had anti-HLA and class II DSA-positive sera (P < .052). C4d staining was associated with higher anti-HLA class I (P = .053) and class I DSA (P = .002) type numbers, and maximal anti-HLA nMFI (P = .036) and was more frequent in AR (P = .048) and class II DSA positive patients (P = .046). Patients with chronic allograft nephropathy showed higher DQ-DSA-nMFI (P = .036). DQ-DSA-nMFI and maximal anti-HLA-nMFI correlated with creatinine increase (Spearman range [SR] = 0.64, SR = 0.41). Together with NBG, maximal class I and class II anti-HLA-nMFI correlated with the number of transplantation and maximal panel-reactive antibodies ratio (SR = 0.19-0.40). CONCLUSIONS Anti-HLA detection allows for humoral AR diagnosis but also for identification of patients with risk of any rejection. However, clear rules of anti-HLA interpretation and studies on their clinical impact are needed.
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Affiliation(s)
- M Nowosiad-Magda
- Department of Microbiology and Immunology, Pomeranian Medical University, Szczecin, Poland.
| | - M Myślak
- Department of Nephrology, Transplantology and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - P Roszkowska
- Department of Microbiology and Immunology, Pomeranian Medical University, Szczecin, Poland
| | - Z Borowiec-Chłopek
- Department of Microbiology and Immunology, Pomeranian Medical University, Szczecin, Poland
| | - E Urasińska
- Departament of Pathology, Pomeranian Medical University, Szczecin, Poland
| | - J Różański
- Department of Nephrology, Transplantology and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - L Domański
- Department of Nephrology, Transplantology and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - K Ciechanowski
- Department of Nephrology, Transplantology and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - S Giedrys-Kalemba
- Department of Microbiology and Immunology, Pomeranian Medical University, Szczecin, Poland
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17
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Ius F, Sommer W, Tudorache I, Kühn C, Avsar M, Siemeni T, Salman J, Hallensleben M, Kieneke D, Greer M, Gottlieb J, Kielstein JT, Boethig D, Welte T, Haverich A, Warnecke G. Preemptive treatment with therapeutic plasma exchange and rituximab for early donor-specific antibodies after lung transplantation. J Heart Lung Transplant 2014; 34:50-58. [PMID: 25447575 DOI: 10.1016/j.healun.2014.09.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 08/07/2014] [Accepted: 09/19/2014] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE De novo donor-specific anti-human leukocyte antigen antibodies develop in a high proportion of lung transplant recipients early after lung transplantation. We recently showed that de novo donor-specific antibodies (DSA) occurrence is associated with significantly increased mortality. Here, we studied the efficacy of a preemptive treatment protocol. METHODS A retrospective observational study was conducted on all lung transplantations at Hanover Medical School between January 2009 and May 2013. RESULTS Among the 500 transplant recipients, early DSA developed in 86 (17%). Of these, 56 patients (65%; Group A) received therapeutic plasma exchange, and 30 patients (35%; Group B) did not. Among Group A patients, 51 also received rituximab. Between groups, there was no statistically significant difference in mortality, incidence of pulsed steroid therapies, rejections diagnosed by biopsy specimen, incidence of bronchitis obliterans syndrome (BOS), or infections requiring hospitalization at 1 year and 3 years. Also, there were no statistically significant differences after matching 21 Group A with 21 Group B patients through propensity score analysis. Significantly more Group A patients (65%) than Group B patients (34%) cleared DSA at hospital discharge (p = 0.01). At the last control after transplantation (median, 14 months; interquartile range, 5-24 months), 11 Group A (22%) and 9 Group B patients (33%) still showed DSA (p = 0.28). CONCLUSIONS Preemptive treatment with therapeutic plasma exchange and rituximab led to improved elimination of DSA early after lung transplantation (p = 0.01). However, spontaneous elimination in untreated Group B patients also occurred frequently. This treatment protocol was not associated with significantly improved outcome.
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Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Wiebke Sommer
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Christian Kühn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | | | - Daniela Kieneke
- Department of Transfusion Medicine, Hanover Medical School, Hanover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hanover Medical School, Hanover, Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hanover Medical School, Hanover, Germany
| | - Jan T Kielstein
- Department of Hypertension and Nephrology, Hanover Medical School, Hanover, Germany
| | - Dietmar Boethig
- Paediatric Cardiology, Hanover Medical School, Hanover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hanover Medical School, Hanover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
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18
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Lobashevsky AL. Methodological aspects of anti-human leukocyte antigen antibody analysis in solid organ transplantation. World J Transplant 2014; 4:153-67. [PMID: 25346888 PMCID: PMC4208078 DOI: 10.5500/wjt.v4.i3.153] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/16/2014] [Accepted: 07/25/2014] [Indexed: 02/05/2023] Open
Abstract
Donor human leukocyte antigen (HLA)-specific antibodies (DSA) play an important role in solid organ transplantation. Preexisting IgG isotype DSA are considered a risk factor for antibody mediated rejection, graft failure or graft loss. The post-transplant development of DSA depends on multiple factors including immunogenicity of mismatched antigens, HLA class II typing of the recipient, cytokine gene polymorphisms, and cellular immunoregulatory mechanisms. De novo developed antibodies require special attention because not all DSA have equal clinical significance. Therefore, it is important for transplant clinicians and transplant immunologists to accurately characterize DSA. In this review, the contemporary immunological techniques for detection and characterization of anti-HLA antibodies and their pitfalls are described.
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19
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Jiang X, Sung YK, Tian W, Qian J, Semenza GL, Nicolls MR. Graft microvascular disease in solid organ transplantation. J Mol Med (Berl) 2014; 92:797-810. [PMID: 24880953 PMCID: PMC4118041 DOI: 10.1007/s00109-014-1173-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 04/29/2014] [Accepted: 05/14/2014] [Indexed: 02/07/2023]
Abstract
Alloimmune inflammation damages the microvasculature of solid organ transplants during acute rejection. Although immunosuppressive drugs diminish the inflammatory response, they do not directly promote vascular repair. Repetitive microvascular injury with insufficient regeneration results in prolonged tissue hypoxia and fibrotic remodeling. While clinical studies show that a loss of the microvascular circulation precedes and may act as an initiating factor for the development of chronic rejection, preclinical studies demonstrate that improved microvascular perfusion during acute rejection delays and attenuates tissue fibrosis. Therefore, preservation of a functional microvasculature may represent an effective therapeutic strategy for preventing chronic rejection. Here, we review recent advances in our understanding of the role of the microvasculature in the long-term survival of transplanted solid organs. We also highlight microvessel-centered therapeutic strategies for prolonging the survival of solid organ transplants.
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Affiliation(s)
- Xinguo Jiang
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA,
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20
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Boulland LML, Naper C, Skauby MH. Presensitization revisited: pitfalls of vascular allografts in transplant candidates. Clin Kidney J 2013; 7:65-67. [PMID: 24466426 PMCID: PMC3901039 DOI: 10.1093/ckj/sft145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 11/12/2013] [Indexed: 11/13/2022] Open
Abstract
Vascular allografts in end-stage renal disease (ESRD) patients represent a particular immunological challenge. A broad HLA immunization led us to study in depth the history of two patients with vascular allografts. In Case 1 the allograft was added to a Gore-Tex graft used for haemodialysis access and no immunosuppression was administered. In Case 2 the allograft was used to prolong a renal artery from living donor and immunosuppression was suboptimal. In vascular surgery, immunosuppression is mainly used to improve graft patency. ESRD patients are potential organ recipients and immunosuppression should therefore be tailored to reduce HLA immunization.
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Affiliation(s)
- Line M L Boulland
- Department of Transplant Medicine , Oslo University Hospital , Oslo , Norway
| | - Christian Naper
- Institute of Immunology , Oslo University Hospital , Oslo , Norway
| | - Morten H Skauby
- Department of Transplant Medicine , Oslo University Hospital , Oslo , Norway
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21
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Choi YJ. Pathologic Updates on Antibody Mediated Rejection in Renal Transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2013. [DOI: 10.4285/jkstn.2013.27.2.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yeong-Jin Choi
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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