The Role of Donor-Specific Antibodies in Intestinal Transplantation: Experience at the University of California Los Angeles and Literature Review.
Authors: Cheng EY, Kaneku H, Farmer DG
Abstract
Intestinal transplantation is a viable treatment strategy for patients with irreversible intestinal failure for whom parenteral nutrition is no longer an option. Although improvements have been made in short-term post-transplant survival outcomes, long-term allograft loss, mainly to acute or chronic rejection, remains a major obstacle to successful transplantation. In all types of solid organ transplants, there is increasing evidence that antibodies directed against human leukocyte antigens, and in particular donor-specific antibodies (DSA), contribute to acu...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
High-Dose Intravenous Immunoglobulin Therapy for Donor Specific Antibodies in Kidney Transplant Recipients with Acute and Chronic Graft Dysfunction: Updates on Previously Reported Cohorts.
Authors: Alfonso J, Gralla J, Klem P, Chan L, Wiseman AC, Cooper JE
Abstract
Kidney allograft damage resulting from donor-specific anti-HLA antibody (DSA) activity has been identified as a key component of long-term graft attrition. DSA that persists following acute antibody-mediated rejection (AMR) episodes and/or DSA associated with chronic graft dysfunction have been shown to be particularly pathogenic. Despite the significantly negative effects of DSA on graft survival, there are currently no accepted treatment modalities. We have previously reported our experience using a regimen of high-dose (5 mg/kg...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Highly Sensitized Patients: Miami Transplant Institute Experience.
CONCLUSIONS: In highly sensitized patients who received desensitization with IVIG, the addition of Rituximab to our standard IS (and/or IVIG and plasmapheresis as per the immunologic risk stratification model) resulted in higher cumulative patient and graft survival.
PMID: 26281142 [PubMed - indexed for MEDLINE] (Source: Clinical Transplants)
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Beyond Criteria and Definitions: Outcome of a Standardized Antibody-Mediated Rejection Protocol with a Diagnostic Schema Different from the Banff 2009 Criteria.
Authors: Rendulic T, Ramon DS, Killen PD, Samaniego-Picota M, Park JM
Abstract
A new clinical diagnostic schema is needed for the diagnosis of antibody-mediated rejection (AMR) in kidney transplant recipients due to the limited utility of C4d staining, lack of standardized quantitative tests for donor specific antibodies, and potential new diagnostic markers. The treatment of AMR remains controversial because previous studies included heterogeneous treatment modalities, small sample sizes, and short follow-up time. At the University of Michigan Transplant Center, 26 patients were diagnosed with AMR based o...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Late Antibody-Mediated Rejection in a Large Prospective Cross-Sectional Study of Kidney Allograft Recipients--Preliminary Results of the Screening Phase of the BORTEJECT Trial.
In conclusion, the results of this cross-sectional analysis suggest a ≥ 6% prevalence of late ABMR. We demonstrate that the more frequent finding of circulating DSA may not necessarily associate with ABMR diagnosis, especially in patients with low antibody levels.
PMID: 26281144 [PubMed - indexed for MEDLINE] (Source: Clinical Transplants)
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Effects of Two Preemptive Post-transplant Desensitization Regimens Upon Renal Allograft Survival and DSA Elaboration.
Authors: Kimball PM, McDougan FA, King A
Abstract
We used a simple point-based algorithm to identify patients who might benefit from desensitization because of their higher risk of antibody-mediated chronic rejection and graft failure. Points were assigned to known but easily determined risk factors (panel reactive antibody, flow crossmatch, delayed graft function) and calculated immediately after deceased donor kidney transplantation. Point totals were used to identify: 1) which patients would receive desensitization; and, 2) which regimen each patient would receive. This standardized approached resulted ...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Early Intervention in Living Kidney Transplantation Based on Dynamic Monitoring of Donor Specific Antibodies.
This study aims to analyze the clinical application of HLA donor specific antibodies (DSA) detected by Luminex single antigen beads and to discuss the impact of early intervention on renal function in DSA positive kidney transplant patients. In 64 cases of living-related renal transplantation, DSA was detected using Luminex single antigen bead assays before and after transplantation. The positive recipients were given intravenous immunoglobulin (IVIG) and increased doses of mycophenolate mofetil (MMF). The relationship between DSA and renal function was analyzed. In all transplant recipients, DSA was negative prior to tran...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Higher Serum Trough Levels of Tacrolimus Increase 5-Year Allograft Survival in Antibody Positive Renal Transplant Patients.
CONCLUSIONS: High-dose tacrolimus might play a role in improving allograft survival in HLA or MICA Ab+ post-transplant patients. Increasing tacrolimus concentration might be a plausible treatment for Ab+ post-transplant patients.
PMID: 26281147 [PubMed - indexed for MEDLINE] (Source: Clinical Transplants)
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Combination of Total Lymphoid Irradiation, Low-Dose IVIG and ATG as Rescue Therapy for Highly Sensitized and Antibody-Mediated Rejection Renal Transplant Recipients.
CONCLUSIONS: Combined therapy of TLI, PP, low-dose IVIG, and ATG is an effective therapeutic measure to reduce the level of HLA antibodies and therefore to desensitize recipients pre-transplant and to reverse AMR post transplant. The potential mechanism of the therapy involves inhibition of B cell proliferation.
PMID: 26281148 [PubMed - indexed for MEDLINE] (Source: Clinical Transplants)
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Treatment of Biopsy-Proven Acute Antibody-Mediated Rejection Using Thymoglobulin (ATG) Monotherapy and a Combination of Rituximab, Intravenous Immunoglobulin, and Plasmapheresis: Lesson Learned from Primary Experience.
CONCLUSIONS: All 5 AMR cases occurred in patients who received renal transplants from HLA highly mismatched DCD donors. Both ATG and rituximab had a significant depleting effect on B cells, but their effects on DSA were not ideal. Mild or moderate acute AMR was ameliorated but not cured by ATG monotherapy. For AMR patient with severe biopsy-proven graft injuries, B cell- and antibody-targeted therapies were not successful since they do not have immediate inhibitory or blocking effects on antibody-caused tissue injury. Therefore, anti-inflammatory, anti-coagulation and complement blockage agents should also be considered as...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Early De Novo Donor Specific Antibody Involvement in Delayed Graft Function After Kidney Transplantation: A Report of 2 Cases.
Authors: Zhu L, Chen G, Zhang W, Guo H, Lin Z, Du D, Chen S, Shi H, Liu S, Chen Z
Abstract
Kidney tubular damage caused by ischemia-reperfusion injury is considered the major cause of delayed graft function (DGF) after renal transplantation. It is not clear whether early generated de novo donor specific antibodies (DSA) play a role in DGF. Here, we report 2 cases of renal transplant with DGF, which seems to be associated with de novo DSA. When the early produced de novo DSA are not potent enough to mediate acute rejection, they may cause mild intra-graft injury, which has a significant impact on the degree...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Allo-Hematopoietic Stem Cell Transplant in China: 2014 Update.
Authors: Lv M, Huang XJ
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) provides powerful curative weapons for patients with certain hematological diseases. Great improvements have been made within recent years, particularly in the fields of haploidentical HSCT, allo-HSCT for aplastic anemia, and strategies to overcome relapse and graft versus host disease. This review updates the current state of allo-HSCT in China.
PMID: 26281151 [PubMed - indexed for MEDLINE] (Source: Clinical Transplants)
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
The Role of HLA Antibodies in HLA Mismatched Allogeneic Hematopoietic Stem Cell Transplantation.
Authors: Zhang X, Wang J, Zhou Z, Zhang Y, Liu H, Tong C, Yu C, Lu Y, Zhao Y, Xiong M, Zhou JR, Juan S, Liu de Y, Wei Z, Zhang J, Wu T, Lu DP
Abstract
Published reports suggest that engraftment failure after hematopoietic stem cell transplantation (HSCT) is closely associated with the presence of donor-specific HLA antibodies (DSA). Herein, we report a single cohort retrospective analysis of 567 cases of HLA mismatched allogeneic HSCT patients from the Lu Dao-pei Hematology Center, transplanted between September 11, 2012, and November 20, 2014. Of these cases, 306 patients underwent HLA class I and II anti...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
