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Killian JT, Houp JA, Burkholder GA, Roman Soto SA, Killian AC, Ong SC, Erdmann NB, Goepfert PA, Hauptfeld-Dolejsek V, Leal SM, Zumaquero E, Nellore A, Agarwal G, Kew CE, Orandi BJ, Locke JE, Porrett PM, Levitan EB, Kumar V, Lund FE. COVID-19 Vaccination and Remdesivir are Associated With Protection From New or Increased Levels of Donor-Specific Antibodies Among Kidney Transplant Recipients Hospitalized With COVID-19. Transpl Int 2022; 35:10626. [PMID: 35928347 PMCID: PMC9343962 DOI: 10.3389/ti.2022.10626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/20/2022] [Indexed: 02/05/2023]
Abstract
Alloimmune responses in kidney transplant (KT) patients previously hospitalized with COVID-19 are understudied. We analyzed a cohort of 112 kidney transplant recipients who were hospitalized following a positive SARS-CoV-2 test result during the first 20 months of the COVID-19 pandemic. We found a cumulative incidence of 17% for the development of new donor-specific antibodies (DSA) or increased levels of pre-existing DSA in hospitalized SARS-CoV-2-infected KT patients. This risk extended 8 months post-infection. These changes in DSA status were associated with late allograft dysfunction. Risk factors for new or increased DSA responses in this KT patient cohort included the presence of circulating DSA pre-COVID-19 diagnosis and time post-transplantation. COVID-19 vaccination prior to infection and remdesivir administration during infection were each associated with decreased likelihood of developing a new or increased DSA response. These data show that new or enhanced DSA responses frequently occur among KT patients requiring admission with COVID-19 and suggest that surveillance, vaccination, and antiviral therapies may be important tools to prevent alloimmunity in these individuals.
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Affiliation(s)
- John T. Killian
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Julie A. Houp
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Greer A. Burkholder
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Salomon A. Roman Soto
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - A. Cozette Killian
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Song C. Ong
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nathaniel B. Erdmann
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Paul A. Goepfert
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Vera Hauptfeld-Dolejsek
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sixto M. Leal
- Department of Pathology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Esther Zumaquero
- Department of Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Anoma Nellore
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gaurav Agarwal
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Clifton E. Kew
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Babak J. Orandi
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jayme E. Locke
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Paige M. Porrett
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Emily B. Levitan
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Vineeta Kumar
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Frances E. Lund
- Department of Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States,*Correspondence: Frances E. Lund,
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2
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Porrett PM, Orandi BJ, Kumar V, Houp J, Anderson D, Cozette Killian A, Hauptfeld-Dolejsek V, Martin DE, Macedon S, Budd N, Stegner KL, Dandro A, Kokkinaki M, Kuravi KV, Reed RD, Fatima H, Killian JT, Baker G, Perry J, Wright ED, Cheung MD, Erman EN, Kraebber K, Gamblin T, Guy L, George JF, Ayares D, Locke JE. First clinical-grade porcine kidney xenotransplant using a human decedent model. Am J Transplant 2022; 22:1037-1053. [PMID: 35049121 DOI: 10.1111/ajt.16930] [Citation(s) in RCA: 173] [Impact Index Per Article: 86.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 01/25/2023]
Abstract
A radical solution is needed for the organ supply crisis, and the domestic pig is a promising organ source. In preparation for a clinical trial of xenotransplantation, we developed an in vivo pre-clinical human model to test safety and feasibility tenets established in animal models. After performance of a novel, prospective compatible crossmatch, we performed bilateral native nephrectomies in a human brain-dead decedent and subsequently transplanted two kidneys from a pig genetically engineered for human xenotransplantation. The decedent was hemodynamically stable through reperfusion, and vascular integrity was maintained despite the exposure of the xenografts to human blood pressure. No hyperacute rejection was observed, and the kidneys remained viable until termination 74 h later. No chimerism or transmission of porcine retroviruses was detected. Longitudinal biopsies revealed thrombotic microangiopathy that did not progress in severity, without evidence of cellular rejection or deposition of antibody or complement proteins. Although the xenografts produced variable amounts of urine, creatinine clearance did not recover. Whether renal recovery was impacted by the milieu of brain death and/or microvascular injury remains unknown. In summary, our study suggests that major barriers to human xenotransplantation have been surmounted and identifies where new knowledge is needed to optimize xenotransplantation outcomes in humans.
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Affiliation(s)
- Paige M Porrett
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Babak J Orandi
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Vineeta Kumar
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Julie Houp
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Douglas Anderson
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - A Cozette Killian
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | | | | | - Sara Macedon
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Natalie Budd
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Katherine L Stegner
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Amy Dandro
- Revivicor, Inc, Blacksburg, Virginia, USA
| | | | | | - Rhiannon D Reed
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Huma Fatima
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - John T Killian
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Gavin Baker
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Jackson Perry
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Emma D Wright
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Matthew D Cheung
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Elise N Erman
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Karl Kraebber
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Tracy Gamblin
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Linda Guy
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - James F George
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | | | - Jayme E Locke
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
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Ladowski JM, Houp J, Hauptfeld-Dolejsek V, Javed M, Hara H, Cooper DKC. Aspects of histocompatibility testing in xenotransplantation. Transpl Immunol 2021; 67:101409. [PMID: 34015463 PMCID: PMC8197754 DOI: 10.1016/j.trim.2021.101409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/14/2021] [Indexed: 12/16/2022]
Abstract
Xenotransplantation, using genetically-modified pigs for clinical organ transplantation, is a solution to the organ shortage. The biggest barrier to clinical implementation is the antigenicity of pig cells. Humans possess preformed antibody to pig cells that initiate antibody-mediated rejection of pig organs in primates. Advances in genetic engineering have led to the development of a pig lacking the three known glycan xenoantigens (triple-knockout [TKO] pigs). A significant number of human sera demonstrate no antibody binding to TKO pig cells. As a result of the TKO pig's low antigen expression, survival of life-supporting pig organs in immunosuppressed nonhuman primates has significantly increased, and hope has been renewed for clinical trials of xenotransplantation. It is important to understand the context in which xenotransplantation's predecessor, allotransplantation, has been successful, and the steps needed for the success of xenotransplantation. Successful allotransplantation has been based on two main immunological approaches - (i) adequate immunosuppressive therapy, and (ii) careful histocompatibility matching. In vivo studies suggest that the available immunosuppressive regimens are adequate to suppress the human anti-pig cellular response. Methods to evaluate and screen patients for the first clinical xenotransplantation trial are the next challenge. The goal of this review is to summarize the history of histocompatibility testing, and the available tools that can be utilized to determine xenograft histocompatibility.
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Affiliation(s)
- Joseph M Ladowski
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Julie Houp
- Histocompatibility Laboratory, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Mariyam Javed
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hidetaka Hara
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - David K C Cooper
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Houp JA, Turner C, Smail AK, Hauptfeld-Dolejsek V. P085 Pre-treatment of patient sera with melon™ gel spin column yields better results in solid phase immunoassays. Hum Immunol 2019. [DOI: 10.1016/j.humimm.2019.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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5
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Yanik MV, Seifert ME, Locke JE, Hauptfeld-Dolejsek V, Crowley MR, Cutter GR, Mannon RB, Feig DI, Limdi NA. CYP3A5 genotype affects time to therapeutic tacrolimus level in pediatric kidney transplant recipients. Pediatr Transplant 2019; 23:e13494. [PMID: 31124575 PMCID: PMC8009482 DOI: 10.1111/petr.13494] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/30/2019] [Accepted: 04/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Optimal management of immunosuppression in kidney transplantation requires a delicate balance of efficacy and toxicity. Tacrolimus (TAC) dose requirements are significantly impacted by genetic variation in CYP3A5 polymorphisms, however the impact that genotype has on clinical outcomes in the pediatric kidney transplant population remains unclear. METHODS We evaluated a retrospective cohort of 98 pediatric kidney transplant recipients. The primary exposure was CYP3A5 genotype, which classified each recipient into the expresser (at least one CYP3A5*1 allele) or non-expresser group (only CYP3A5*3 alleles). The primary outcome was time to achieve a steady therapeutic TAC concentration. Secondary outcomes include incidence of early allograft rejection and calcineurin inhibitor (CNI) nephrotoxicity during the first year post-transplant. RESULTS The study cohort included 55 (56%) expressers and 43 (44%) non-expressers of the CYP3A5*1 allele. Expressers had a significantly longer time to achieve a steady therapeutic TAC concentration than non-expressers (log rank, P = 0.03). Expressers had a trend for higher incidence of early allograft rejection (29.1% vs 16.3%, log rank, P = 0.16). Early biopsy-proven CNI nephrotoxicity was seen in 60% of recipients, with no differences in the rate between expressers and non-expressers. CONCLUSIONS Pediatric kidney transplant recipients with the CYP3A5*1 allele (expressers) take a longer time to achieve therapeutic TAC levels than those with the CYP3A5*3 allele (non-expressers). However, we observed no significant differences in acute rejection or CNI nephrotoxicity based on CYP3A5 genotype. Thus CYP3A5 genotype was not observed to have an immediate impact on early transplant outcomes.
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Affiliation(s)
- Megan V. Yanik
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael E. Seifert
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jayme E. Locke
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, Alabama
| | - Vera Hauptfeld-Dolejsek
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael R. Crowley
- Heflin Center for Genomic Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gary R. Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roslyn B. Mannon
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel I. Feig
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nita A. Limdi
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
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6
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Ladowski JM, Martens GR, Reyes LM, Hauptfeld-Dolejsek V, Tector M, Tector J. Examining epitope mutagenesis as a strategy to reduce and eliminate human antibody binding to class II swine leukocyte antigens. Immunogenetics 2019; 71:479-487. [PMID: 31270568 DOI: 10.1007/s00251-019-01123-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/14/2019] [Indexed: 11/26/2022]
Abstract
Xenotransplantation of pig organs into people may help alleviate the critical shortage of donors which faces organ transplantation. Unfortunately, human antibodies vigorously attack pig tissues preventing the clinical application of xenotransplantation. The swine leukocyte antigens (SLA), homologs of human HLA molecules, can be xenoantigens. SLA molecules, encoded by genes in the pig major histocompatibility complex, contribute to protective immune responses in pig. Therefore, simply inactivating them through genome engineering could reduce the ability of the human immune system to surveil transplanted pig organs for infectious disease or the development of neoplasms. A potential solution to this problem is to identify and modify epitopes in SLA proteins to eliminate their contribution to humoral xenoantigenicity while retaining their biosynthetic competence and ability to contribute to protective immunity. We previously showed that class II SLA proteins were recognized as xenoantigens and mutating arginine at position 55 to proline, in an SLA-DQ beta chain, could reduce human antibody binding. Here, we extend these observations by creating several additional point mutants at position 55. Using a panel of monoclonal antibodies specific for class II SLA proteins, we show that these mutants remain biosynthetically competent. Examining antibody binding to these variants shows that point mutagenesis can reduce, eliminate, or increase antibody binding to class II SLA proteins. Individual mutations can have opposite effects on antibody binding when comparing samples from different people. We also performed a preliminary analysis of creating point mutants near to position 55 to demonstrate that manipulating additional residues also affects antibody reactivity.
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Affiliation(s)
- Joseph M Ladowski
- Department of Surgery, University of Alabama at Birmingham, ZRB 701, 1720 2nd Ave South, Birmingham, AL, 35294, USA
| | - Gregory R Martens
- Department of Surgery, University of Alabama at Birmingham, ZRB 701, 1720 2nd Ave South, Birmingham, AL, 35294, USA
| | - Luz M Reyes
- Department of Surgery, University of Alabama at Birmingham, ZRB 701, 1720 2nd Ave South, Birmingham, AL, 35294, USA
| | - Vera Hauptfeld-Dolejsek
- Department of Surgery, University of Alabama at Birmingham, ZRB 701, 1720 2nd Ave South, Birmingham, AL, 35294, USA
- Transplant Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Matthew Tector
- Department of Surgery, University of Alabama at Birmingham, ZRB 701, 1720 2nd Ave South, Birmingham, AL, 35294, USA
- Transplant Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph Tector
- Department of Surgery, University of Alabama at Birmingham, ZRB 701, 1720 2nd Ave South, Birmingham, AL, 35294, USA.
- Transplant Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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7
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Seifert ME, Yanik MV, Feig DI, Hauptfeld-Dolejsek V, Mroczek-Musulman EC, Kelly DR, Rosenblum F, Mannon RB. Subclinical inflammation phenotypes and long-term outcomes after pediatric kidney transplantation. Am J Transplant 2018; 18:2189-2199. [PMID: 29766640 PMCID: PMC6436389 DOI: 10.1111/ajt.14933] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/02/2018] [Accepted: 05/06/2018] [Indexed: 01/25/2023]
Abstract
The implementation of surveillance biopsies in pediatric kidney transplantation remains controversial. Surveillance biopsies detect subclinical injury prior to clinical dysfunction, which could allow for early interventions that prolong allograft survival. We conducted a single-center retrospective cohort study of 120 consecutive pediatric kidney recipients, of whom 103 had surveillance biopsies ≤6 months posttransplant. We tested the hypothesis that subclinical inflammation (borderline or T cell-mediated rejection without clinical dysfunction) is associated with a 5-year composite endpoint of acute rejection and allograft failure. Overall, 36% of subjects had subclinical inflammation, which was associated with increased hazard for the composite endpoint (adjusted hazard ratio 2.89 [1.27, 6.57]; P < .01). Subjects with treated vs untreated subclinical borderline rejection had a lower incidence of the composite endpoint (41% vs 67%; P < .001). Subclinical vascular injury (subclinical inflammation with Banff arteritis score > 0) had a 78% incidence of the composite endpoint vs 11% in subjects with no major surveillance abnormalities (P < .001). In summary, we showed that subclinical inflammation phenotypes were prevalent in pediatric kidney recipients without clinical dysfunction and were associated with increased acute rejection and allograft failure. Once prospectively validated, our data would support implementation of surveillance biopsies as standard of care in pediatric kidney transplantation.
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Affiliation(s)
- Michael E. Seifert
- Department of Pediatrics, University of Alabama School of Medicine, Birmingham, Alabama
| | - Megan V. Yanik
- Department of Pediatrics, University of Alabama School of Medicine, Birmingham, Alabama
| | - Daniel I. Feig
- Department of Pediatrics, University of Alabama School of Medicine, Birmingham, Alabama
| | - Vera Hauptfeld-Dolejsek
- Department of Surgery, University of Alabama School of Medicine, Birmingham, Alabama,Comprehensive Transplant Institute, University of Alabama School of Medicine, Birmingham, Alabama
| | - Elizabeth C. Mroczek-Musulman
- Children’s of Alabama, Birmingham, Alabama,Department of Pathology, University of Alabama School of Medicine, Birmingham, Alabama
| | - David R. Kelly
- Children’s of Alabama, Birmingham, Alabama,Department of Pathology, University of Alabama School of Medicine, Birmingham, Alabama
| | - Frida Rosenblum
- Department of Pathology, University of Alabama School of Medicine, Birmingham, Alabama
| | - Roslyn B. Mannon
- Department of Surgery, University of Alabama School of Medicine, Birmingham, Alabama,Comprehensive Transplant Institute, University of Alabama School of Medicine, Birmingham, Alabama,Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama
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8
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Ladowski JM, Martens GR, Reyes LM, Wang ZY, Eckhoff DE, Hauptfeld-Dolejsek V, Tector M, Tector AJ. Examining the Biosynthesis and Xenoantigenicity of Class II Swine Leukocyte Antigen Proteins. J Immunol 2018. [PMID: 29540579 DOI: 10.4049/jimmunol.1800022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Genetically engineered pig organs could provide transplants to all patients with end-stage organ failure, but Ab-mediated rejection remains an issue. This study examines the class II swine leukocyte Ag (SLA) as a target of epitope-restricted Ab binding. Transfection of individual α- and β-chains into human embryonic kidney cells resulted in both traditional and hybrid class II SLA molecules. Sera from individuals on the solid organ transplant waiting list were tested for Ab binding and cytotoxicity to this panel of class II SLA single-Ag cells. A series of elution studies from an SLA-DQ cell line were performed. Our results indicate that human sera contain Abs specific for and cytotoxic against class II SLA. Our elution studies revealed that sera bind the SLA-DQ molecule in an epitope-restricted pattern. Site-specific mutation of one of these epitopes resulted in statistically decreased Ab binding. Humans possess preformed, specific, and cytotoxic Abs to class II SLA that bind in an epitope-restricted fashion. Site-specific epitope mutagenesis may decrease the Ab binding of highly sensitized individuals to pig cells.
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Affiliation(s)
- Joseph M Ladowski
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294; and
| | - Gregory R Martens
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294; and
| | - Luz M Reyes
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294; and
| | - Zheng-Yu Wang
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294; and
| | - Devin E Eckhoff
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294; and
| | | | - Matt Tector
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294; and
| | - A Joseph Tector
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294; and
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9
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Ong SC, White J, Hauptfeld-Dolejsek V, Kumar V. Outcomes in Simultaneous Liver Kidney Transplants in the Setting of a Positive Crossmatch: A Single Center Experience. Clin Transpl 2016; 32:119-125. [PMID: 28564529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Recent literature suggests that a positive crossmatch adversely impacts outcomes in simultaneous liver-kidney transplant (SLKT). The aim of this study was to evaluate outcomes of SLKT with a positive flow crossmatch (+FCXM) at our center. We retrospectively analyzed all of the SLKTs between January 1, 2000, and September 30, 2010. A total of 2793 kidney transplants and 892 liver transplants were performed in this time period, of which, 31 were SLKT (3%). Seven of the 31 (22%) SLKTs had a +FCXM. There were 3 major adverse events: 1 patient mortality at 9 months with liver failure; 1 allograft nephrectomy for primary nonfunction secondary to hyper-acute rejection; and, 1 recurrent liver allograft rejection with eventual graft loss and death at 26 months post-transplant. The median follow-up time was 34 months. The 3-year overall SLKT patient survival in the negative FCXM (-FCXM) patients was 85% compared with 71% in the +FCXM group. The rates of acute liver and kidney rejection were 6% and 10%, respectively, in the -FCXM group compared to 14% and 28%, respectively, in the +FCXM group. A very strongly +FCXM with a mean channel shift above 4 times the positive cut-off and the presence of multiple strong donor-specific antibodies (DSA) with mean fluorescence intensity (MFI) above 10,000 were associated with poorer outcome. In conclusion, in patients with very strongly +FCXM with high MFI DSA, proceeding with the transplantation leads to poor outcomes.
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Affiliation(s)
- Song C Ong
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL
| | - Jared White
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL
| | | | - Vineeta Kumar
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL
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10
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Hauptfeld-Dolejsek V, Tao Z. 33-P Search for clinical relevance of antibody detection. Hum Immunol 2011. [DOI: 10.1016/j.humimm.2011.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Hauptfeld-Dolejsek V, Kumar V, Tao Z. 82-P Outcome of simultaneous liver kidney transplant (SLKT) across a flow positive crossmatch. Hum Immunol 2011. [DOI: 10.1016/j.humimm.2011.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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McKenzie Masi S, Hauptfeld-Dolejsek V. Case for performing high resolution for low resolution matched siblings. Hum Immunol 2004. [DOI: 10.1016/j.humimm.2004.07.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Hauptfeld-Dolejsek V, Shreffler DC. Antigenic properties of 36 new H-2 congenic strains and 4 independently derived strains, W10LT, DDD, BZH, and FM. Immunogenetics 1989; 30:132-6. [PMID: 2759664 DOI: 10.1007/bf02421544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- V Hauptfeld-Dolejsek
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110
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14
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Affiliation(s)
- V Hauptfeld-Dolejsek
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110
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15
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Hauptfeld-Dolejsek V, Vaidya HC, Shreffler DC. Immune response gene control of the mouse antibody responses to human creatine kinase-MM and the lactate dehydrogenase-1 enzymes. Immunogenetics 1989; 30:128-31. [PMID: 2527197 DOI: 10.1007/bf02421543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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