Clinical transplants最新文献

HLA Matching HLA匹配

Clinical transplants Pub Date : 2020-02-07 DOI: 10.32388/tmfo97

引用次数: 11

Clinical transplants Pub Date : 2019-06-14 DOI: 10.2307/j.ctvh9w1pp.10

E. Gamboa, O. Bronsther, N. Halasz

引用次数: 7

Late Antibody-Mediated Rejection in Kidney Transplant Recipients: Outcomes after Intravenous Immunoglobulin Therapy. 肾移植受者晚期抗体介导的排斥反应:静脉免疫球蛋白治疗后的结果。

Clinical transplants Pub Date : 2016-01-01

Gaurav Agarwal, Charles D Diskin, Timothy A Williams, Vineeta Kumar

{"title":"Late Antibody-Mediated Rejection in Kidney Transplant Recipients: Outcomes after Intravenous Immunoglobulin Therapy.","authors":"Gaurav Agarwal, Charles D Diskin, Timothy A Williams, Vineeta Kumar","doi":"","DOIUrl":"","url":null,"abstract":"Development of acute antibody-mediated rejection (AMR) is associated with graft loss and can occur both early (<3 months) and late (>3 months) post-transplant. Treatment and prognosis differ in early and late AMR. Herein, we present a single-center experience using high-dose intravenous immunoglobulin (IVIg) (2g/kg) for the treatment of late AMR. All kidney recipients with negative T- and B-cell flow crossmatch at transplant and biopsy-proven late AMR were included (2009-2013, n=126). All patients were treated with IVIg at 2g/kg over divided doses and high-dose intravenous methylprednisolone. Variables collected included demographics, Banff 2007 renal allograft biopsy scoring criteria, and laboratory values. Multivariable Cox proportional hazard regression was used to identify factors predictive of graft loss. Median age was 46 years, with 60% male and 47.6% African American. Median time from transplant to rejection was 3.8 years. Baseline serum creatinine was 1.6 mg/dl and median serum creatinine at diagnosis was 2.6 mg/dl. Fifty-eight patients (46%) eventually lost their grafts at a median of 12 months (interquartile range: 4-21) from diagnosis. Serum creatinine >5.3 mg/dl at time of diagnosis was associated with a 94% probability of graft loss, and after controlling for multiple recipient and donor factors, only serum creatinine and urine protein creatinine ratio at diagnosis were predictive of graft loss. Late AMR has a poor prognosis, with 46% graft loss at a median follow-up of 12 months. Serum creatinine was a better predictor of subsequent graft failure than histological characteristics in late AMR. These findings help inform treatment plans as well as prognosis.","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"32 ","pages":"111-118"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35045321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Outcomes in Simultaneous Liver Kidney Transplants in the Setting of a Positive Crossmatch: A Single Center Experience. 交叉配型阳性的同时进行肝肾移植的结果:单中心经验。

Clinical transplants Pub Date : 2016-01-01

Song C Ong, Jared White, Vera Hauptfeld-Dolejsek, Vineeta Kumar

{"title":"Outcomes in Simultaneous Liver Kidney Transplants in the Setting of a Positive Crossmatch: A Single Center Experience.","authors":"Song C Ong, Jared White, Vera Hauptfeld-Dolejsek, Vineeta Kumar","doi":"","DOIUrl":"","url":null,"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.","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"32 ","pages":"119-125"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35045322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intestinal Bioengineering. 肠道生物工程。

Clinical transplants Pub Date : 2016-01-01

James C Y Dunn

引用次数: 0

Donor-Specific HLA Antibodies: A Review of Data Published in 2016. 供体特异性HLA抗体:2016年发表的数据综述

Clinical transplants Pub Date : 2016-01-01

Adam Idica, Matthew J Everly

引用次数: 0

HLA Epitopes - Are We Ready for Clinical Prime Time? Historic Perspective and Future Needs. HLA表位-我们准备好临床黄金时间了吗?历史观点和未来需求。

Clinical transplants Pub Date : 2016-01-01

Reut H Dvorai, David F Pinelli, Anat R Tambur

引用次数: 0

From Accurate Assessment of Anti-HLA Antibody MFI to Complement-Binding Assays. 从抗hla抗体MFI的准确评估到补体结合检测。

Clinical transplants Pub Date : 2016-01-01

Guillaume Claisse, Christophe Mariat, Nicolas Maillard

{"title":"From Accurate Assessment of Anti-HLA Antibody MFI to Complement-Binding Assays.","authors":"Guillaume Claisse, Christophe Mariat, Nicolas Maillard","doi":"","DOIUrl":"","url":null,"abstract":"Single antigen bead (SAB) and complement-binding assays are commonly used to monitor immunization in transplant patients. Like all new diagnostic assays, some considerations have to be appreciated to avoid a biased utilization. By truly decreasing antibody concentration, SAB monitoring in sensitized patients experiencing apheresis offers a good opportunity to explore analytical interference. We explored analytical artifacts by analyzing the role of prozone and saturation effects through a concrete example of a single patient who experienced immunoadsorption. We then assessed, on a larger cohort, the link between an accurate assessment of mean fluorescence intensity (MFI) and the C1q and C3d binding assays. Finally, we compared MFI with the two main available SAB assays. After immunoadsorption, the MFI of some antibodies unexpectedly rose. We showed that this increase was due, in part, to both a prozone effect and a saturation of the beads. Dithiothreitol treatment appeared to be an efficient way to avoid a prozone effect. The analysis of dilution profile was an interesting tool to detect a saturation effect. The comparison of the two main SABs revealed a systematic difference of 3000 MFI. MFI was a strong predictor of C1q and C3d positivity. Complement-positive antibodies had a higher MFI (p<0.01). Despite the great contribution of SAB assays in anti-HLA antibody assessment, the knowledge of analytical interference is necessary to avoid any misleading conclusions. With regard to the interference between MFI and complement-binding assays, their place in risk stratification has to be clarified.","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"32 ","pages":"153-160"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35047248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

C1q Donor-Specific Antibody Associates with Post-transplant Biopsy Findings in Highly- Sensitized Kidney Transplant Recipients. C1q供体特异性抗体与高敏感肾移植受者移植后活检结果相关。

Clinical transplants Pub Date : 2016-01-01

Sarat Kuppachi, Danniele Holanda, Sara Gallegos, Elizabeth H Field

{"title":"C1q Donor-Specific Antibody Associates with Post-transplant Biopsy Findings in Highly- Sensitized Kidney Transplant Recipients.","authors":"Sarat Kuppachi, Danniele Holanda, Sara Gallegos, Elizabeth H Field","doi":"","DOIUrl":"","url":null,"abstract":"Donor-specific anti-human leukocyte antigen antibodies (DSA) are associated with antibody-mediated rejection (AMR) in kidney transplantation, but the spectrum of graft injury seen in patients with DSA ranges from no damage to florid rejection. Since immunoglobulin G (IgG) antibodies with cytotoxic potential can be distinguished by their binding complement fraction C1q, the level of C1q-binding IgG (C1q+) DSA may be useful for stratifying risk or diagnosing AMR. We therefore investigated the value of IgG and C1q+ DSA in predicting pathologic features of AMR on kidney biopsies. We tested the associations between DSA at different cut-off levels and pathologic features of AMR on biopsy in a cohort of consecutive, highly-sensitized patients transplanted after December 2014 who had 1-, 3-, and 6-month protocol kidney biopsies and monitoring for IgG and C1q+ DSA. Eight patients with cPRA >90% and negative flow crossmatch underwent kidney transplant and completed six months of follow-up contributing 23 pairs of biopsy/ serum samples for analysis. C1q+ DSA was significantly associated with C4d finding on biopsy at mean fluorescence intensity (MFI) cut-offs of >100 (p=0.046) and >300 (p=0.008) and showed superior positive and negative predictive value in comparison to conventional IgG DSA. C1q+ DSA also showed significant association and good predictive value for any AMR feature on biopsy (p=0.003, for >100 MFI; p=0.005 for >300 MFI), while IgG DSA showed no association. In a small cohort of high cPRA transplant recipients, C1q+ DSA outperformed IgG DSA as an indicator of AMR biopsy findings. Including C1q+ DSA testing in post-transplant DSA monitoring of highly-sensitized patients may aid the timely diagnosis of AMR.","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"32 ","pages":"127-134"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35045323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Acute Rejection in 6-Antigen HLA-Matched Kidney Transplant Recipients: Risk Factors and Outcomes from the Wisconsin Allograft Recipient Database (WisARD). 6抗原hla匹配肾移植受者的急性排斥反应:来自威斯康星同种异体移植受者数据库(WisARD)的危险因素和结果

Clinical transplants Pub Date : 2016-01-01

Amanda J Condon, Brad C Astor, Kimberly E Holdener, Thomas M Ellis, Arjang Djamali

{"title":"Acute Rejection in 6-Antigen HLA-Matched Kidney Transplant Recipients: Risk Factors and Outcomes from the Wisconsin Allograft Recipient Database (WisARD).","authors":"Amanda J Condon, Brad C Astor, Kimberly E Holdener, Thomas M Ellis, Arjang Djamali","doi":"","DOIUrl":"","url":null,"abstract":"Acute rejection in human leukocyte antigen (HLA)-matched kidney transplant recipients is uncommon and the mechanisms involved are not well understood. Data from 6-antigen HLA-matched recipients transplanted between 1994 and 2014 were analyzed to identify the incidence, risk factors, and outcomes associated with biopsy-proven acute rejection (BPAR). A total of 278 HLA-matched recipients were identified, of which, 155 (55.8%) received a graft from a sibling donor. Ten patients (3.6%) experienced BPAR over a median follow-up of 10 years (0.41 cases per 100 person-years). Median time to rejection was 36.5 months (standard deviation ±56.4). Recipients who experienced rejection did not differ from those who did not in terms of age, gender, ethnicity, induction agent, panel reactive antibody, or sensitizing events. Acute cellular, antibody-mediated, and mixed rejection occurred in 5, 3, and 2 patients, respectively. The most common biopsy classification was Banff IA (n=4). Four out of 10 patients had documented nonadherence to maintenance immunosuppression. Thirty percent of HLA-matched recipients who rejected had graft loss and 10% died, compared to 30.8% graft loss and 28.4% deaths in non-rejectors (p=0.57 and 0.20, respectively). In conclusion, acute cellular and antibody-mediated rejection are infrequent in HLA-matched kidney transplant recipients. Nonadherence appears to be relatively common among those experiencing rejection. Acute rejection was not associated with higher graft loss or death. The pathogenesis of acute rejection in HLA-matched recipients remains to be determined.","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"32 ","pages":"135-141"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35045324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0