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Lee JH, Koo TY, Lee JE, Oh KH, Kim BS, Yang J. Impact of sensitization and ABO blood types on the opportunity of deceased-donor kidney transplantation with prolonged waiting time. Sci Rep 2024; 14:2635. [PMID: 38302674 PMCID: PMC10834527 DOI: 10.1038/s41598-024-53157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/29/2024] [Indexed: 02/03/2024] Open
Abstract
The waiting time to deceased-donor kidney transplantation (DDKT) is long in Asian countries. We investigated the impact of sensitization and ABO blood type (ABO) on DDKT opportunity using two Korean cohorts: a hospital cohort from two centers and a national database. The impact of panel reactive antibody (PRA) based on the maximal PRA% and ABO on DDKT accessibility was analyzed using a competing risks regression model. In the hospital cohort (n = 4722), 88.2%, 8.7%, and 3.1% of patients belonged to < 80%, 80-99%, and ≥ 99% PRA groups, respectively, and 61.1%, 11.6%, and 27.3% belonged to A or B, AB, and O blood types, respectively. When PRA and ABO were combined, PRA < 80%/A or B and 80 ≤ PRA < 99%/AB had fewer DDKT opportunities (median, 12 years; subdistribution hazard ratio [sHR], 0.71) compared with PRA < 80%/AB (median, 11 years). Also, PRA < 80%/O, 80 ≤ PRA < 99%/A or B, and PRA ≥ 99%/AB had a much lower DDKT opportunity (median, 13 years; sHR, 0.49). Furthermore, 80 ≤ PRA < 99%/O and PRA ≥ 99%/non-AB had the lowest DDKT opportunity (sHR, 0.28). We found similar results in the national cohort (n = 18,974). In conclusion, an integrated priority system for PRA and ABO is needed to reduce the inequity in DDKT opportunities, particularly in areas with prolonged waiting times.
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Affiliation(s)
- Jin Hyeog Lee
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Tai Yeon Koo
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jung Eun Lee
- Division of Nephrology, Department of Internal Medicine, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Kook Hwan Oh
- Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Beom Seok Kim
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Jaeseok Yang
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
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Ballou C, Barton F, Payne EH, Berney T, Villard J, Meier RPH, Baidal D, Alejandro R, Robien M, Eggerman TL, Kamoun M, Muller YD. Matching for HLA-DR excluding diabetogenic HLA-DR3 and HLA-DR4 predicts insulin independence after pancreatic islet transplantation. Front Immunol 2023; 14:1110544. [PMID: 37026004 PMCID: PMC10070978 DOI: 10.3389/fimmu.2023.1110544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/16/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction In pancreatic islet transplantation, the exact contribution of human leukocyte antigen (HLA) matching to graft survival remains unclear. Islets may be exposed to allogenic rejection but also the recurrence of type 1 diabetes (T1D). We evaluated the HLA-DR matching, including the impact of diabetogenic HLA-DR3 or HLA-DR4 matches. Methods We retrospectively examined the HLA profile in 965 transplant recipients and 2327 islet donors. The study population was obtained from patients enrolled in the Collaborative Islet Transplant Registry. We then identified 87 recipients who received a single-islet infusion. Islet-kidney recipients, 2nd islet infusion, and patients with missing data were excluded from the analysis (n=878). Results HLA-DR3 and HLA-DR4 were present in 29.7% and 32.6% of T1D recipients and 11.6% and 15.8% of the donors, respectively. We identified 52 T1D islet recipients mismatched for HLA-DR (group A), 11 with 1 or 2 HLA-DR-matches but excluding HLA-DR3 and HLA- DR4 (group B), and 24 matched for HLA-DR3 or HLA-DR4 (group C). Insulin-independence was maintained in a significantly higher percentage of group B recipients from year one through five post-transplantation (p<0.01). At five-year post-transplantation, 78% of group B was insulin-independent compared to 24% (group A) and 35% (group C). Insulin-independence correlated with significantly better glycemic control (HbA1c <7%), fasting blood glucose, and reduced severe hypoglycemic events. Matching HLA-A-B-DR (≥3) independently of HLA- DR3 or HLA-DR4 matching did not improve graft survival. Conclusion This study suggests that matching HLA-DR but excluding the diabetogenic HLA-DR3 and/or 4 is a significant predictor for long-term islet survival.
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Affiliation(s)
- Cassandra Ballou
- Collaborative Islet Transplant Registry Coordinating Center, The EMMES Company, LLC, Rockville, MD, United States
- *Correspondence: Yannick D. Muller, ; Cassandra Ballou,
| | - Franca Barton
- Collaborative Islet Transplant Registry Coordinating Center, The EMMES Company, LLC, Rockville, MD, United States
| | - Elizabeth H. Payne
- Collaborative Islet Transplant Registry Coordinating Center, The EMMES Company, LLC, Rockville, MD, United States
| | - Thierry Berney
- Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Jean Villard
- Department of Genetic, Laboratory and Pathology Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Raphael P. H. Meier
- Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - David Baidal
- Department of Medicine and the Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Rodolfo Alejandro
- Department of Medicine and the Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Mark Robien
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Thomas L. Eggerman
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Malek Kamoun
- Immunology and Histocompatibility Testing Laboratory, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Yannick D. Muller
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- *Correspondence: Yannick D. Muller, ; Cassandra Ballou,
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Loga L, Dican L, Matei HV, Mărunțelu I, Constantinescu I. Relevant biomarkers of kidney allograft rejection. J Med Life 2022; 15:1330-1333. [PMID: 36567832 PMCID: PMC9762359 DOI: 10.25122/jml-2022-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/19/2022] [Indexed: 12/27/2022] Open
Abstract
This review focuses on the new relevant biomarkers proposed for the diagnosis of different types of allograft rejections. The immune response against the transplanted tissues can lead to rejection. Kidney allograft rejection occurs when the recipient component's immune system reacts against the donor's cells. MicroRNAs, dd-cf DNA, CD103 markers, CXCR3 chemokine receptor, IP-10, KIR genes, HLA antibodies, the perforin and granzyme B molecules - the constant assessment of all these parameters could prevent acute rejection episodes and kidney injuries. In this way, both immune response and tissue destruction biomarkers are essential for the long-term survival of kidney-transplanted patients. They also contribute to personalizing treatments, precisely personalized immunosuppressive regiments.
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Affiliation(s)
- Luminița Loga
- Clinical Institute of Urology and Renal Transplant, Cluj-Napoca, Romania,Department of Cell and Molecular Biology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lucia Dican
- Clinical Institute of Urology and Renal Transplant, Cluj-Napoca, Romania,Department of Biochemistry, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horea Vladi Matei
- Department of Cell and Molecular Biology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ion Mărunțelu
- Immunology and Transplant Immunology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,Centre of Immunogenetics and Virology, Fundeni Clinical Institute, Bucharest, Romania,Corresponding Author: Ion Mărunțelu, Immunology and Transplant Immunology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. Centre of Immunogenetics and Virology, Fundeni Clinical Institute, Bucharest, Romania. E-mail:
| | - Ileana Constantinescu
- Immunology and Transplant Immunology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,Centre of Immunogenetics and Virology, Fundeni Clinical Institute, Bucharest, Romania
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Duff CE, Simmonds MJ. Genetic predictors of long-term graft function in kidney and pancreas transplant patients. Brief Funct Genomics 2017; 16:228-237. [PMID: 28110269 DOI: 10.1093/bfgp/elw039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Kidney and pancreas transplantation have helped transform the lives of people with end-stage renal failure and individuals with type 1 diabetes who have poor glycaemic control/severe secondary complications, respectively. Despite an improvement in immunosuppressive regimes, operative techniques and decreased initial rejection rates, there has been little improvement in long-term graft survival rates over the past decade. Whilst limited progress has been made in establishing clinical markers of graft function, several genetic markers of long-term graft function have been identified. These genetic markers have the potential to (i) assist in selecting marginal donor organs for transplantation, (ii) provide better understanding of the mechanisms behind graft loss enabling identification of new, or repurposing, current treatments to extend graft function and (iii) provide a window of opportunity to identify and treat individuals before graft failure has occurred. This review will discuss the different genetic variants screened for a role in predicting transplant longevity, examine their findings and limitations and introduce where the future of genetic research within the transplantation field lies.
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[Determination of HLA-A, -B and -DRB1 polymorphism in brain dead organ donors representative of the Colombian general population, 2007-2014]. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2017; 37:184-190. [PMID: 28527282 DOI: 10.7705/biomedica.v37i2.3263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Genes encoding for human leukocyte antigens (HLA) are highly polymorphic and of great importance in organ transplantation procedures, as determining allelic frequencies in defined populations is taken into account among the scientific criteria for organ allocation. OBJECTIVE The objective of this study was to establish the antigen HLA-A, -B, and -DRB1 haplotype frequencies in organ donors representative of the Colombian population after brain death. MATERIALS AND METHODS We conducted a descriptive retrospective study involving 2,506 cadaveric organ donors including an allelic and haplotype analysis of HLA-A, -B and -DRB1; we also determined the Hardy-Weinberg equilibrium. RESULTS We identified 21, 43 and 15 allelic loci for groups A*, B* and DRB1*, respectively. We detected 1,268 HLA-A, -B and -DR, 409 HLA-A-B, 383 HLA-DR-B, and 218 HLA-A-DR haplotypes. The three loci were found to be in Hardy-Weinberg equilibrium between the number of heterozygotes observed and the expected number, with p values of ;0.05. CONCLUSIONS This study provides information on the allelic distribution of HLA class I and II in organ donors from the six regions in which Colombia is structurally divided to provide transplant services.
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Mosaad YM, Mansour M, Al-Muzairai I, Al-Otabi T, Abdul-Moneam M, Al-Attiyah R, Shahin M. Association between Human Leukocyte Antigens (HLA-A, -B, and -DR) and end-stage renal disease in Kuwaiti patients awaiting transplantation. Ren Fail 2014; 36:1317-21. [PMID: 25010329 DOI: 10.3109/0886022x.2014.937672] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The number of patients with end stage renal disease (ESRD) is increasing considerably worldwide. Human Leukocyte Antigens (HLAs) are relevant for the expression of many immunological diseases and contribute to the development of different nephropathies. Therefore, we aimed from the present work to investigate the possible association between the frequency of HLA-A, -B, and -DR antigens and ESRD in Kuwaiti patients awaiting renal transplant. HLA-A, -B, and -DR typing was performed by complement-dependent cytotoxicity (CDC) method for 334 patients with ESRD awaiting renal transplantation and 191 healthy controls. The frequency of HLA-B8 antigen was significantly higher in ESRD patients (OR = 2.62, p = 0.001, pc = 0.038), and the frequency of HLA-A28, HLA-DR11 antigens was significantly higher in healthy controls (OR 0.42, p = 0.0001; pc = 0.0021, and OR = 0.44, p = 0.0007, pc = 0.01 respectively). While the HLA-B8 antigen may be a susceptibility risk factor for development of ESRD, the HLA-A28, and HLA-DR11 antigens may be protective against development of ESRD in Kuwaiti population.
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Affiliation(s)
- Youssef M Mosaad
- Clinical Immunology Unit, Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura University , Mansoura , Egypt
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Ansari D, Bućin D, Nilsson J. Human leukocyte antigen matching in heart transplantation: systematic review and meta-analysis. Transpl Int 2014; 27:793-804. [PMID: 24725030 DOI: 10.1111/tri.12335] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/16/2014] [Accepted: 04/07/2014] [Indexed: 11/29/2022]
Abstract
Allocation of donors with regard to human leukocyte antigen (HLA) is controversial in heart transplantation. This paper is a systematic review and meta-analysis of the available evidence. PubMed, Embase, and the Cochrane Library were searched systematically for studies that addressed the effects of HLA matching on outcome after heart transplantation. Fifty-seven studies met the eligibility criteria. 34 studies had graft rejection as outcome, with 26 of the studies reporting a significant reduction in graft rejection with increasing degree of HLA matching. Thirteen of 18 articles that reported on graft failure found that it decreased significantly with increasing HLA match. Two multicenter studies and nine single-center studies provided sufficient data to provide summary estimates at 12 months. Pooled comparisons showed that graft survival increased with fewer HLA-DR mismatches [0-1 vs. 2 mismatches: risk ratio (RR) = 1.09 (95% confidence interval (CI): 1.01-1.19; P = 0.04)]. Having fewer HLA-DR mismatches (0-1 vs. 2) reduced the incidence of acute rejection [(RR = 0.81 (0.66-0.99; P = 0.04)]. Despite the considerable heterogeneity between studies, the short observation time, and older data, HLA matching improves graft survival in heart transplantation. Prospective HLA-DR matching is clinically feasible and should be considered as a major selection criterion.
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Affiliation(s)
- David Ansari
- Division of Cardiothoracic Surgery, Department of Clinical Sciences Lund, Lund University and Skane University Hospital, Lund, Sweden
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Almoguera B, Shaked A, Keating BJ. Transplantation genetics: current status and prospects. Am J Transplant 2014; 14:764-78. [PMID: 24618335 DOI: 10.1111/ajt.12653] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 12/17/2013] [Accepted: 12/31/2013] [Indexed: 01/25/2023]
Abstract
Over the last decade, advances in genetic technologies have accelerated our understanding of the genetic diversity across individuals and populations. Case-control and population-based studies have led to several thousand genetic associations across a range of phenotypes and traits being unveiled. Despite widespread and successful use of organ transplantation as a curative therapy for organ failure, genetic research has yet to make a major impact on transplantation practice aside from HLA matching. New studies indicate that non-HLA loci, termed minor histocompatibility antigens (mHAs), may play an important role in graft rejection. With several million common and rare polymorphisms observed between any two unrelated individuals, a number of these polymorphisms represent mHAs, and may underpin transplantation rejection. Genetic variation is also recognized as contributing to clinical outcomes including response to immunosuppressants, introducing the possibility of genotype-guided prescribing in the very near future. This review summarizes existing knowledge of the impact of genetics on transplantation outcomes and therapeutic responses, and highlights the translational potential that new genomic knowledge may bring to this field.
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Affiliation(s)
- B Almoguera
- The Center for Applied Genomics, Abramson Research Center, The Children's Hospital of Philadelphia, PA
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Relative Importance of HLA Mismatch and Donor Age to Graft Survival in Young Kidney Transplant Recipients. Transplantation 2013; 96:469-75. [DOI: 10.1097/tp.0b013e318298f9db] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yu X, Song B, Huang C, Xiao Y, Fang M, Feng J, Wang P, Zhang G. Prolonged survival time of allografts by the oral administration of RDP58 linked to the cholera toxin B subunit. Transpl Immunol 2012; 27:122-7. [PMID: 22709942 DOI: 10.1016/j.trim.2012.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 01/19/2023]
Abstract
Oral administration, which has been identified as a tool for boosting physiological immunoregulatory mechanisms in an antigen-specific manner, is a more convenient way than classical parenteral injection methods. RDP58 is derived from specific regions of class-I MHC molecules and is known to have immunomodulatory effects after intraperitoneal injection or intravenous administration. To determine whether the oral administration of RDP58 conjugated to the cholera toxin B subunit (CTB) can better induce peripheral tolerance than the use of traditional methods, we used various feeding regimens and methods of administration using equivalent doses of antigen during rat kidney transplantation. The results showed that RDP58-GC/CTB treatment increased the activity of Haem oxygenase-1 (HO-1) in vivo and significantly improved the survival and histopathology of allograft kidney tissue relative to the oral administration of RDP58 alone. These results suggest that the administration of RDP58 linked to CTB outweighs the benefits of oral administration of RDP58 alone for prolonging the survival time of kidney transplantation. This study supports the potential therapeutic use of oral administration of RDP58 linked to CTB as a platform molecule in the treatment of allograft rejection.
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Affiliation(s)
- Xuesong Yu
- Urological Research Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, 400036, China
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