Clinical transplants最新文献_第3页

Pre-empting Antibody-Mediated Rejection: A Program of DSA Monitoring and Treatment Can Effectively Prevent Antibody Mediated Rejection. 预防抗体介导的排斥反应:DSA监测和治疗方案可以有效预防抗体介导的排斥反应。

Clinical transplants Pub Date : 2016-01-01

Alexander Gilbert, Monica Grafals, Olga Timofeeva, Misbah Zaheer, Abdullah Karabala, Sandra Rosen-Bronson, Dong Li, Mariam Awwad, Peter Abrams, Jack Moore, Basit Javaid, Jennifer Verbesey, Seyed Ghasemian, Matthew Cooper

{"title":"Pre-empting Antibody-Mediated Rejection: A Program of DSA Monitoring and Treatment Can Effectively Prevent Antibody Mediated Rejection.","authors":"Alexander Gilbert, Monica Grafals, Olga Timofeeva, Misbah Zaheer, Abdullah Karabala, Sandra Rosen-Bronson, Dong Li, Mariam Awwad, Peter Abrams, Jack Moore, Basit Javaid, Jennifer Verbesey, Seyed Ghasemian, Matthew Cooper","doi":"","DOIUrl":"","url":null,"abstract":"Antibody-mediated rejection (AMR) remains a problem without a reliable treatment in the care of kidney transplant patients. We proposed and tested a program of screening for donor specific antibodies (DSA) to initiate treatment of patients before AMR was detected and to prevent its occurrence. Starting in April 2012, we stratified patients into high-, medium-, and low-risk groups for the development of DSA and instituted a program of screening for and treatment of these antibodies. We used a historic control group of patients transplanted at our center as a comparator and looked at rates of DSA testing and development as well as rates of development of AMR, cell-mediated rejection, and graft loss. 614 patients were transplanted under the protocol compared with 266 patients in the control group. Length of follow-up was similar in both groups. The group undergoing DSA screening had lower rates of DSA development (17.6% versus 24.8%, p=0.016) and that DSA was found at a significantly earlier time post-transplant (147 versus 248 days, p=0.02). Incidence of AMR was dramatically lower in the screened group (1.3% versus 8.6%, p<0.0001) with no grafts lost due to AMR. AMR was found to occur at an average of 181 days post-transplant. Rates of acute cellular rejection did not decrease in a manner similar to AMR rates. In conclusion, a program of universal risk-stratified DSA testing in kidney transplant patients can dramatically reduce rates of AMR and virtually eliminate graft loss due to AMR.","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"32 ","pages":"93-101"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35045319","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

Risk Stratification of Human Leukocyte Antigen Class II Donor Specific Antibody Positive Patients by Immunoglobulin G Subclasses. 人白细胞抗原II类供体特异性抗体阳性患者免疫球蛋白G亚类的风险分层。

Clinical transplants Pub Date : 2015-01-01

Michiko Taniguchi, Lorita M Rebellato, Kimberly P Briley, Carl E Haisch, Paul Bolin, Nubia Banuelos, Judy Hopfield, Paul I Terasaki, Matthew J Everly

{"title":"Risk Stratification of Human Leukocyte Antigen Class II Donor Specific Antibody Positive Patients by Immunoglobulin G Subclasses.","authors":"Michiko Taniguchi, Lorita M Rebellato, Kimberly P Briley, Carl E Haisch, Paul Bolin, Nubia Banuelos, Judy Hopfield, Paul I Terasaki, Matthew J Everly","doi":"","DOIUrl":"","url":null,"abstract":"Background: Human leukocyte antigen (HLA) antibodies are a major cause of graft loss in mismatched transplant recipients. However, the time to graft loss resulting from antibody induced injury is unpredictable. The unpredictable nature of antibodies may be related to the subclass of antibodies. In this study, HLA immunoglobulin G (IgG) subclasses were investigated to determine whether a unique IgG subclass composition could better identify those patients at eminent risk for graft loss.Methods: The serial serum samples from the 57 patients with post-transplant HLA class II donor specific antibodies (DSA) were tested for the three IgG subclasses (IgG1, IgG3, and IgG4).Results: IgG3 and IgG4 were highly prevalent in failed patients compared to functioning patients (82 % vs. 34%, 45% vs. 20%, respectively). IgG3 development showed a distinct subclass trend between failed and functioning patients with poor graft survival (log rank p=0.0006). IgG1 was almost equally abundant in both groups (100% and 97%, respectively). Of the 5 patterns of IgG subclass combinations observed, IgG1+3+ showed the strongest association with graft failure (hazard ratio 3.14, p=0.007).Conclusion: Patients with IgG3 subclass HLA DSA showed lower graft survival. Post-transplant monitoring for IgG subclasses rather than total IgG monitoring may identify patients at risk for graft failure.","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"293-301"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35003078","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

Kidney Transplant Survival: Transforming Early Post-Transplant Opportunities to Long-Term Success. 肾移植生存:将早期移植后机会转化为长期成功。

Clinical transplants Pub Date : 2015-01-01

Rajil Mehta, Aravind Cherukuri, Puneet Sood, Chethan Puttarajappa, William Hoffman, Christine Wu, Nirav Shah, Sundaram Hariharan

{"title":"Kidney Transplant Survival: Transforming Early Post-Transplant Opportunities to Long-Term Success.","authors":"Rajil Mehta, Aravind Cherukuri, Puneet Sood, Chethan Puttarajappa, William Hoffman, Christine Wu, Nirav Shah, Sundaram Hariharan","doi":"","DOIUrl":"","url":null,"abstract":"Substantial strides have been made in improving the short-term success after kidney transplantation. Although there has been some progress, there has not been a robust improvement with respect to long-term outcomes. However, there remain many potentially modifiable transplant-specific risks to long-term patient and graft survival. In this chapter, we detail the current state of five important short-term transplant-specific clinical events. The early post-transplant events that negatively impact long-term survival discussed in this chapter are: acute T cell mediated rejection, acute antibody mediated rejection, delayed graft function, post-transplant viral infections, and recurrent and de novo diseases after transplantation. This chapter focuses on unmet needs and outlines important goals, specific to each of the topics, that hold promise for achieving better long-term graft survival in kidney transplant patients. Consistent across all five areas are: the need for better standardization and improvement in diagnosis and testing, identification of relevant clinical surrogate markers in the design of new studies, newer immunosuppressive agents, anti-viral agents and targeted therapy for certain diseases, and innovative newer clinical trials. A multifaceted approach will further enhance long-term kidney transplant survival.","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"227-237"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35003612","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

Long-Term Pancreas Allograft Survival in Simultaneous Pancreas-Kidney Transplantation by Era. 胰肾联合移植中同种异体胰腺的长期存活。

Clinical transplants Pub Date : 2015-01-01

Kayo Waki, Aki Hayashi, Satoko Yamaguchi, Masaomi Nangaku, Kazuhiko Ohe, Takashi Kadowaki, Norihiro Kokudo

{"title":"Long-Term Pancreas Allograft Survival in Simultaneous Pancreas-Kidney Transplantation by Era.","authors":"Kayo Waki, Aki Hayashi, Satoko Yamaguchi, Masaomi Nangaku, Kazuhiko Ohe, Takashi Kadowaki, Norihiro Kokudo","doi":"","DOIUrl":"","url":null,"abstract":"Data collected by the United Network for Organ Sharing from all approved United States transplant programs were analyzed; the data included 20,290 adult diabetic patients who received primary pancreas transplants between October 1987 and December 2014. Simultaneous pancreas-kidney (SPK) transplantation has become the major therapeutic option for diabetes patients. The number of SPKs per year has not increased since 1999; it leveled off or decreased slightly each year. Recipients in the most recent period, 2010-2014, were more likely than recipients in any of the other periods to be non-white, older, male, to have had diabetes longer, to have higher body mass indices; and in this group there were more donor-recipient human leukocyte antigen mismatches. Donors in the 2010-2014 period were more likely to be younger and male and less likely to be white. Pancreas graft survival rates were highest in the 2010-2014 period (one-year graft survival 89.7%) vs. those for 1987-1989 (74.6%), 1990- 1994 (77.5%), 1995-1999 (82.9%), 2000-2004 (84.4%), and 2005-2009 (85.5%); the five-year rates were 72.7% for 2010-14 vs. 60.0%, 64.3%, 69.0%, 70.9%, and 73.9% for the other periods, respectively. There was no decreased risk of graft failure for recent-era transplants compared with those of 1987-1989, except for those in 2005-2009. By year of transplant, the adjusted hazard ratios [with 95% confidence intervals (CI)] for overall loss of grafts surviving over one year in eras 1990-1994, 1995-1999, 2000-2004, 2005-2009, and 2010-2014 were, respectively, 0.85 (CI 0.66-1.09), 0.85 (CI 0.66- 1.09), 0.87 (CI 0.67-1.13), 0.71 (CI 0.54-0.93), and 0.86 (CI 0.64-1.15). Chronic rejection caused 44.9% of graft losses between one and five years and 51.5% after five years. There is a need for a means to identify early markers of chronic rejection-and to control it-to improve long-term survival.","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"35-42"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35004322","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

Alloantibodies in Organ Transplant: A Review of Data Published in 2015. 器官移植中的同种异体抗体:2015年发表的数据综述

Clinical transplants Pub Date : 2015-01-01

Curtis Maehara, Matthew J Everly

引用次数: 0

There is a Road, No Simple Highway: Envisioning a Path to Better Long-Term Organ Transplant Survival. 有一条路，没有简单的高速公路:设想一条更好的长期器官移植生存之路。

Clinical transplants Pub Date : 2015-01-01

Matthew J Everly

引用次数: 0

Advancing Lung Transplantation. 推进肺移植。

Clinical transplants Pub Date : 2015-01-01

Ramsey R Hachem

引用次数: 0

A Review of the Management of Pregnancy After Cardiac Transplantation. 心脏移植术后妊娠的处理综述。

Clinical transplants Pub Date : 2015-01-01

Diane D Tran, Jon Kobashigawa

{"title":"A Review of the Management of Pregnancy After Cardiac Transplantation.","authors":"Diane D Tran, Jon Kobashigawa","doi":"","DOIUrl":"","url":null,"abstract":"Success and advances in the management of all aspects of heart disease and heart transplantation have allowed for normalcy in life, including the question as to the possibility of pregnancy in transplantation. With the growing young adult population undergoing heart transplant, pregnancy and transplantation have become an issue of importance. Despite the fact that nearly 50 years have passed since the first heart transplant, there remains to be little evidence in regard to management of pregnant heart transplant recipients. Thus, this review will address issues related to pregnancy in this patient population, such as preconception counseling, timing and optimization for pregnancy post transplant, immunosuppression, cardiac assessment, and management of pregnant heart transplant recipients, as well as hemodynamic effects of pregnancy on the transplanted heart. Based on the available literature from registrar data, case reports and series, with careful planning, monitoring, and appropriate therapies, pregnancy in heart transplantation is a viable option in select patients. To optimize maternal and fetal outcomes, recommendations are included in this review to minimize complications including rejection, graft dysfunction, maternal diabetes and hypertension, as well as appropriate changes in immunosuppression.","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"151-161"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35003606","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

An Update on Cardiac Transplantation in the United States Based on an Analysis of the UNOS Registry. 基于UNOS登记分析的美国心脏移植的最新进展。

Clinical transplants Pub Date : 2015-01-01

Juhi R Khatiwala, Matthew J Everly

引用次数: 0

C1q Assay Results in Complement-Dependent Cytotoxicity Crossmatch Negative Renal Transplant Candidates with Donor-Specific Antibodies: High Specificity But Low Sensitivity When Predicting Flow Crossmatch. 补体依赖性细胞毒性交叉配型阴性肾移植候选人供体特异性抗体的C1q检测结果:在预测血流交叉配型时，高特异性但低敏感性。

Clinical transplants Pub Date : 2015-01-01

José M Arreola-Guerra, Luis E Morales-Buenrostro, Natalia Castelán, Adrián de Santiago, Adriana Arvizu, Norma Gonzalez-Tableros, Mayra López, Mario Vilatobá, Julio Granados, Josefina Alberú

引用次数: 0