Transplant immunology最新文献

{"title":"The protective effect of Cloprostenol on ischemia/reperfusion injury in rat ovary: Histopathologic and immunohistochemically evaluation: An experimental study","authors":"Savas Karakus ,&nbsp;Halef Okan Dogan ,&nbsp;Mustafa Özkaraca","doi":"10.1016/j.trim.2024.102108","DOIUrl":"10.1016/j.trim.2024.102108","url":null,"abstract":"<div><h3>Objectıves</h3><p>This study investigates whether Cloprostenol, a synthetic prostaglandin analog, could protect against ischemia/reperfusion (IR) injury in rat ovaries.</p></div><div><h3>Methods</h3><p>Adult female rats were divided into four groups: Sham groups, ischemia (IS) groups, ischemia/reperfusion (IR) groups, and Cloprostenol-treated (CT) groups. The IR injury model was established by clamping the ovarian pedicle for a specified period, followed by reperfusion. The CT group received a pre-treatment of Cloprostenol before inducing ischemia. Ovarian tissues were collected for histological, and immunohistochemical examination.</p></div><div><h3>Results</h3><p>The IS group exhibited severe morphological damage to ovarian tissues, including disrupted tissue architecture and increased apoptosis (<em>p</em> &lt; 0.001). In contrast, the CT group displayed significantly improved ovarian histology, with notable preservation of ovarian tissue and reduced apoptotic activity (<em>p</em> &lt; 0.01). Immunohistochemical analysis revealed that the levels of 8-Hydroxy-2-deoxyguanosine (8-OHdG), Caspase 3, Cyclooxygenase 2 (COX-2), and Interleukin 1 beta (IL-1β) staining, which were elevated in the IS and IR groups, were significantly diminished in the CT group (<em>p</em> &lt; 0.05).</p></div><div><h3>Conclusıon</h3><p>Cloprostenol administration before IR injury in rat ovaries demonstrated a remarkable protective effect by improving histological damage and reducing DNA damage inflammation. These results highlight the therapeutic potential of Cloprostenol in safeguarding ovarian health against IR.</p></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"86 ","pages":"Article 102108"},"PeriodicalIF":1.6,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single cell RNA-sequencing identifies the effect of Normothermic ex vivo liver perfusion on liver-resident T cells","authors":"David Al-Adra ,&nbsp;Ruoxin Lan ,&nbsp;Heather Jennings ,&nbsp;Kristin N. Weinstein ,&nbsp;Yongjun Liu ,&nbsp;Bret Verhoven ,&nbsp;Weifeng Zeng ,&nbsp;Grace Heise ,&nbsp;Mia Levitsky ,&nbsp;Peter Chlebeck ,&nbsp;Yao-Zhong Liu","doi":"10.1016/j.trim.2024.102104","DOIUrl":"10.1016/j.trim.2024.102104","url":null,"abstract":"<div><h3>Background</h3><p>Normothermic ex vivo liver perfusion (NEVLP) is an exciting strategy to preserve livers prior to transplant, however, the effects of NEVLP on the phenotype of tissue-resident immune cells is largely unknown. The presence of tissue-resident memory T cells (TRM) in the liver may protect against acute rejection and decrease allograft dysfunction. Therefore, we investigated the effects of NEVLP on liver TRMs and assessed the ability of anti-inflammatory cytokines to reduce TRM activation during NEVLP.</p></div><div><h3>Methods</h3><p>Rat livers underwent NEVLP with or without the addition of IL-10 and TGF-β. Naïve and cold storage livers served as controls. Following preservation, TRM T cell gene expression profiles were assessed through single cell RNA sequencing (scRNA-seq). Differential gene expression analysis was performed with Wilcoxon rank sum test to identify differentially expressed genes (DEGs) associated with a specific treatment group. Using the online Database for Annotation, Visualization and Integrated Discovery (DAVID), gene set enrichment was then conducted with Fisher's exact test on DEGs to highlight differentially regulated pathways and functional terms associated with treatment groups.</p></div><div><h3>Results</h3><p>Through scRNA-seq analysis, an atlas of liver-resident memory T cell subsets was created for all livers. TRM T cells could be identified in all livers, and through scRNA-seq, DEG was identified with Wilcoxon rank sum test at FDR &lt; 0.05. Based on the gene set enrichment analysis of DEGs using Fisher's exact test, NEVLP is associated with downregulation of multiple gene enrichment pathways associated with surface proteins. Furthermore, NEVLP with anti-inflammatory cytokines was associated with down regulation of 52 genes in TRM T cells when compared to NEVLP alone (FDR &lt;0.05), most of which are pro-inflammatory.</p></div><div><h3>Conclusion</h3><p>This is the first study to create an atlas of liver TRM T cells in the rat liver undergoing NEVLP and demonstrate the effects of NEVLP on liver TRM T cells at the single cell gene expression level.</p></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"86 ","pages":"Article 102104"},"PeriodicalIF":1.6,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful treatment with mesenchymal stem cells for steroid-refractory late-onset idiopathic pneumonia syndrome following allogeneic hematopoietic cell transplantation","authors":"Soichiro Nakako ,&nbsp;Hideo Koh ,&nbsp;Nobuhiro Sogabe ,&nbsp;Masatomo Kuno ,&nbsp;Yosuke Makuuchi ,&nbsp;Teruhito Takakuwa ,&nbsp;Hiroshi Okamura ,&nbsp;Mitsutaka Nishimoto ,&nbsp;Yasuhiro Nakashima ,&nbsp;Masayuki Hino ,&nbsp;Hirohisa Nakamae","doi":"10.1016/j.trim.2024.102107","DOIUrl":"10.1016/j.trim.2024.102107","url":null,"abstract":"<div><p>The reportedly poor outcome of late-onset idiopathic pneumonia syndrome (IPS) necessitates new approaches to its treatment. A 55-year-old man who had undergone allogeneic hematopoietic cell transplantation (allo-HCT) for myelodysplastic syndrome 1 year ago developed dyspnea with acute skin graft-versus-host disease (GVHD) flare-up while tapering immunosuppressive agents. He presented with acute respiratory distress syndrome with ground-glass opacities in the right upper and left lower lobes. All infectious tests, including multiplex polymerase chain reaction of nasal wash, were negative, and broad-spectrum antibiotic therapy was refractory. The patient was diagnosed with late-onset IPS and was refractory to methylprednisolone pulse therapy. He then showed a favorable response to mesenchymal stem cell (MSC) infusion. After eight infusions of MSCs, he had no IPS recurrence for over one year. Recently, preclinical studies have reported the potential therapeutic utility of MSC infusion for treating IPS, and our case supports its potential for treating late-onset IPS.</p></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"86 ","pages":"Article 102107"},"PeriodicalIF":1.6,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adipose tissue–derived mesenchymal stem cells promote the vascularization of pancreatic islets transplanted into decellularized pancreatic skeletons","authors":"Klára Zacharovová ,&nbsp;Zuzana Berková ,&nbsp;Peter Girman ,&nbsp;František Saudek","doi":"10.1016/j.trim.2024.102106","DOIUrl":"10.1016/j.trim.2024.102106","url":null,"abstract":"<div><p>We have recently developed a model of pancreatic islet transplantation into a decellularized pancreatic tail in rats. As the pancreatic skeletons completely lack endothelial cells, we investigated the effect of co-transplantation of mesenchymal stem cells and endothelial cells to promote revascularization.</p><p>Decellularized matrix of the pancreatic tail was prepared by perfusion with Triton X-100, sodium dodecyl sulfate and DNase solution. Isolated pancreatic islets were infused into the skeletons via the splenic vein either alone, together with adipose tissue–derived mesenchymal stem cells (adMSCs), or with a combination of adMSCs and rat endothelial cells (rat ECs). Repopulated skeletons were transplanted into the subcutaneous tissue and explanted 9 days later for histological examination. Possible immunomodulatory effects of rat adMSCs on the survival of highly immunogenic green protein–expressing human ECs were also tested after their transplantation beneath the renal capsule. The immunomodulatory effects of adMSCs were also tested in vitro using the Invitrogen Click-iT EdU system.</p><p>In the presence of adMSCs, the proliferation of splenocytes as a response to phytohaemagglutinin A was reduced by 47% (the stimulation index decreased from 1.7 to 0.9, <em>P</em> = 0.008) and the reaction to human ECs was reduced by 58% (the stimulation index decreased from 1.6 to 0.7, <em>P</em> = 0.03). Histological examination of the explanted skeletons seeded only with the islets showed their partial disintegration and only a rare presence of CD31-positive cells. However, skeletons seeded with a combination of islets and adMSCs showed preserved islet morphology and rich vascularity. In contrast, the addition of syngeneic rat ECs resulted in islet-cell necrosis with only few endothelial cells present. Live green fluorescence–positive endothelial cells transplanted either alone or with adMSCs were not detected beneath the renal capsule.</p><p>Though the adMSCs significantly reduced in vitro proliferation stimulated by either phytohaemagglutinin A or by xenogeneic human ECs, in vivo co-transplanted adMSCs did not suppress the post-transplant immune response to xenogeneic ECs. Even in the syngeneic model, ECs co-transplantation did not lead to sufficient vascularization in the transplant area. In contrast, islet co-transplantation together with adMSCs successfully promoted the revascularization of extracellular matrix in the subcutaneous tissue.</p></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"86 ","pages":"Article 102106"},"PeriodicalIF":1.6,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0966327424001229/pdfft?md5=928f67ff0532fd1680115f9879e3654f&pid=1-s2.0-S0966327424001229-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vagal nerve stimulation potential therapeutic benefits in acute lung rejection and transplantation","authors":"Shaun Edalati ,&nbsp;J. Sam Meyer ,&nbsp;Dan Aravot ,&nbsp;Yaron D. Barac","doi":"10.1016/j.trim.2024.102105","DOIUrl":"10.1016/j.trim.2024.102105","url":null,"abstract":"<div><p>Allograft rejection, accompanied by a rise in proinflammatory cytokines, is a leading cause of morbidity and mortality after lung transplantation. Immunosuppressive treatments are routinely employed as an effective way to prevent rejection, however, there is still an unmet need to develop new strategies to reduce the damage caused to transplanted organs by innate inflammatory responses. Recent research has shown that activating the vagus nerve's efferent arm regulates cytokine production and improves survival in experimental conditions of cytokine excess, such as sepsis, hemorrhagic shock, ischemia-reperfusion injury, among others. The cholinergic anti-inflammatory pathway can provide a localized, fast, and discrete response to inflammation by controlling the neuroimmune response and preventing excessive inflammation. This review intends to assess and discuss, the influence of noninvasive vagal nerve stimulation for prophylactic measures and supporting treatment in patients undergoing organ transplantation rejection with a prominent T-cell mediated immune response as a means of attenuating inflammation and leukocyte infiltration of the graft vessels.</p></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"86 ","pages":"Article 102105"},"PeriodicalIF":1.6,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor-derived cytomegalovirus-specific CD8+ T cells restricted to shared, donor-specific, or host-specific HLA after HLA mismatched hematopoietic stem cell transplantation","authors":"Kazuhiro Ikegame ,&nbsp;Keiko Fukunaga ,&nbsp;Yuko Osugi ,&nbsp;Katsuji Kaida ,&nbsp;Masahiro Teramoto ,&nbsp;Takayuki Inoue ,&nbsp;Masaya Okada ,&nbsp;Kyoko Yoshihara ,&nbsp;Hiroya Tamaki ,&nbsp;Satoshi Yoshihara ,&nbsp;Hiroshi Fujiwara","doi":"10.1016/j.trim.2024.102099","DOIUrl":"10.1016/j.trim.2024.102099","url":null,"abstract":"<div><p>Immune reconstitution after human leukocyte antigen (HLA)-mismatched (haploidentical) hematopoietic stem cell transplantation (haplo-HCT) can significantly influence long-term outcomes. The three possible HLA haplotypes after transplantation are: one carried by both the patient and the donor (shared HLA), one by donor only (donor-specific HLA), and one by patient only (host-specific HLA), and the donor T cells remain restricted to one of these three haplotypes. Understanding the presence of donor T cells restricted to each haplotype may provide more detailed insights into post-transplant immune response and potentially provide valuable information for the development of chimeric antigen receptor T cell or T cell receptor T cell constructs. In this study, patients or donors with HLA-A24 or HLA-A2 were tested with HLA-A*24:02- and A*02:01-restricted cytomegalovirus (CMV)-specific tetramers for detecting the respective HLA-restricted T cells. Sixty-four samples from 40 patients were assayed. More than half of the patients at day 90 and all patients by day 900 had shared HLA-restricted T cells. After day 90, half of the patients had donor-specific HLA-restricted T cells, but no host-specific HLA-restricted T cells were found. In the comparative analysis of the transplant types, shared HLA-restricted T cells were positive in all three categories: haplo-HCT (50%), 2-haplo-mis-HCT (75%), and spousal HCT (67%). Furthermore, donor-specific HLA-restricted T cells demonstrated positivity in haplo-HCT at 57% and in 2-haplo-mis-HCT at 60%, with a threshold of 0.01%. Donor-specific HLA-restricted T cells for spousal HCT were not examined due to the lack of an appropriate HLA combination for the tetramers.</p><p>The presence of shared HLA-restricted T cells explains the host defense after HLA-haploidentical transplantation, while the presence of donor-specific HLA-restricted T cells may account for host defense against hematotropic viruses, such as CMV. However, this study failed to detect host-specific HLA-restricted T cells, leaving the host defense against epitheliotropic viruses unresolved, thus requiring further investigation.</p></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"87 ","pages":"Article 102099"},"PeriodicalIF":1.6,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Major drug-drug interaction between sirolimus and apalutamide in a liver transplant recipient","authors":"Jérôme Dumortier ,&nbsp;Marc Colombel ,&nbsp;Denis Maillet","doi":"10.1016/j.trim.2024.102103","DOIUrl":"10.1016/j.trim.2024.102103","url":null,"abstract":"","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"86 ","pages":"Article 102103"},"PeriodicalIF":1.6,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"APOD: A biomarker associated with oxidative stress in acute rejection of kidney transplants based on multiple machine learning algorithms and animal experimental validation","authors":"Jun Pei ,&nbsp;Jie Zhang ,&nbsp;Chengjun Yu ,&nbsp;Jin Luo ,&nbsp;Yi Hua ,&nbsp;Guanghui Wei","doi":"10.1016/j.trim.2024.102101","DOIUrl":"10.1016/j.trim.2024.102101","url":null,"abstract":"<div><h3>Background</h3><p>Oxidative stress is an unavoidable process in kidney transplantation and is closely related to the development of acute rejection after kidney transplantation. This study aimed to investigate the biomarkers associated with oxidative stress and their potential biological functions during acute rejection of kidney transplants.</p></div><div><h3>Methods</h3><p>We identified Hub genes using five machine learning algorithms based on differentially expressed genes (DEGs) in the kidney transplant acute rejection dataset GSE50058 and oxidative stress-related genes (OS) obtained from the MSigDB database, and validated them with the datasets GSE1563 and GSE9493, as well as with animal experiments; Subsequently, we explored the potential biological functions of Hub genes using single-gene GSEA enrichment analysis; The Cibersort algorithm was used to explore the altered levels of infiltration of 22 immune cells during acute rejection of renal transplantation, and a correlation analysis between Hub genes and immune cells was performed; Finally, we also explored transcription factors (TFs), miRNAs, and potential drugs that regulate Hub genes.</p></div><div><h3>Results</h3><p>We obtained a total of 57 genes, which we defined as oxidative stress-associated differential genes (DEOSGs), after intersecting DEGs during acute rejection of kidney transplants with OSs obtained from the MSigDB database; The results of enrichment analysis revealed that DEOSGs were mainly enriched in response to oxidative stress, response to reactive oxygen species, and regulation of oxidative stress and reactive oxygen species; Subsequently, we identified one Hub gene as APOD using five machine learning algorithms, which were validated by validation sets and animal experiments; The results of single-gene GSEA enrichment analysis revealed that APOD was closely associated with the regulation of immune signaling pathways during acute rejection of kidney transplants; The Cibersort algorithm found that the infiltration levels of a total of 10 immune cells were altered in acute rejection, while APOD was found to correlate with the expression of multiple immune cells; Finally, we also identified 154 TFs, 12 miRNAs, and 12 drugs or compounds associated with APOD regulation.</p></div><div><h3>Conclusion</h3><p>In this study, APOD was identified as a biomarker associated with oxidative stress during acute rejection of kidney transplants using multiple machine learning algorithms, which provides a potential therapeutic target for mitigating oxidative stress injury and reducing the incidence of acute rejection in kidney transplantation.</p></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"86 ","pages":"Article 102101"},"PeriodicalIF":1.6,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune response against bacterial infection in organ transplant recipients","authors":"Amir Elalouf,&nbsp;Amit Yaniv-Rosenfeld,&nbsp;Hanan Maoz","doi":"10.1016/j.trim.2024.102102","DOIUrl":"10.1016/j.trim.2024.102102","url":null,"abstract":"<div><p>This comprehensive review delves into the intricate dynamics between the immune system and bacterial infections in organ transplant recipients. Its primary objective is to fill existing knowledge gaps while critically assessing the strengths and weaknesses of current research. The paper accentuates the delicate balance that must be struck between preventing graft rejection through immunosuppression and maintaining robust immunity against bacterial threats. In this context, personalized medicine emerges as a transformative concept, offering the potential to revolutionize clinical outcomes by tailoring immunosuppressive regimens and vaccination strategies to the unique profiles of transplant recipients. By emphasizing the pivotal role of continuous monitoring, the review underscores the necessity for vigilant surveillance of transplant recipients to detect bacterial infections and associated immune responses early, thereby reducing the risk of severe infections and ultimately improving patient outcomes. Furthermore, the study highlights the significance of the host microbiome in shaping immune responses, suggesting that interventions targeting the microbiome hold promise for enhancing bacterial immunity in transplant recipients, both in research and clinical practice. In terms of future research directions, the review advocates for large-scale, longitudinal studies encompassing diverse patient cohorts to provide more comprehensive insights into post-transplant immune responses. It also advocates integrating multi-omics approaches, including genomics, transcriptomics, proteomics, and microbiome data, to understand immune responses and their underlying mechanisms. In conclusion, this review significantly enriches our understanding of immune responses in transplant recipients. It paves the way for more effective and personalized approaches to managing infections in this complex setting.</p></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"86 ","pages":"Article 102102"},"PeriodicalIF":1.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative outcomes of DSA positive, crossmatch negative living donor kidney transplants versus remaining on the waitlist for an HLA compatible deceased donor","authors":"Eva Santos ,&nbsp;Gaetano Lucisano ,&nbsp;Frank J.M.F. Dor ,&nbsp;Michelle Willicombe","doi":"10.1016/j.trim.2024.102098","DOIUrl":"10.1016/j.trim.2024.102098","url":null,"abstract":"<div><h3>Introduction</h3><p>The clinical relevance of preformed donor specific antibodies in the setting of a negative crossmatch (DSA + XM-) remains controversial. In this study we investigate the outcomes of patients with a DSA + XM- living donor (LDi) who proceeded with an HLA-incompatible (HLAi) transplant compared with those who waited for an HLA-compatible deceased donor (DDc).</p></div><div><h3>Materials and methods</h3><p>We investigated 359 patients on the transplant waiting list who had at least one potential HLAi living donor, from which 203 DSA + XM- pairs were identified and outcomes analysed.</p></div><div><h3>Results</h3><p>Out of 203 patients, 96 (47.3%) received a LD transplant: 52/96 (54.2%) a LDi, and 44/96 (45.8%) an alternative compatible LD. In addition, 107 patients out of 203(52.7%) waited for a DDc, of which 47(43.9%) were subsequently transplanted. Our adjusted analysis showed that the LDi transplantation did not offer a superior patient survival over waiting for a DDc transplant. For those transplanted, there was no difference in patient (<em>p</em> = 0.065) or death censored allograft survival (<em>p</em> = 0.37) between DDc and LDi recipients. However, there was a higher incidence of acute allograft rejection (<em>p</em> = 0.043) and antibody-mediated rejection (<em>p</em> = 0.005) in the LDi group. Having a high pre-transplant calculated reaction frequency and preformed DSA to both class I and class II antigens were associated with inferior outcomes in the LDi transplants.</p></div><div><h3>Conclusions</h3><p>Given the lack of difference in allograft survival between LDi and DDc transplants, in the absence of an alternative compatible living donor, proceeding with a LDi should be supported despite a higher rejection risk, providing individual risk assessment and shared decision making is undertaken.</p></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"86 ","pages":"Article 102098"},"PeriodicalIF":1.6,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}