| Autor: |
Steiger, J. U., Bielmann, D., Hönger, G., Mayr, M., Dickenmann, M., Palmer, E. |
| Předmět: |
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| Zdroj: |
Kidney & Blood Pressure Research; 2004, Vol. 27 Issue 5/6, p338-339, 2p |
| Abstrakt: |
Objective: Two grafts were lost in our centre due to peracute rejection. Both were females who had children from their living kidney donor 20 years before transplantation. Although PRA (panel reactive antibodies) and crossmatch (XM) before transplantation were negative, we suspected a previous immunisation, which was not detected with conventional CDC techniques. DST boosts the potential recipient with HLA molecules from the donor to reveal the presence of B cells producing low levels of anti-donor Abs. Previously immunised recipients should display an easily detectable antibody titer with CDC technique following DST, while DST should not induce anti-donor Abs in non-immunised patients. The pitfall is that DST might actually induce an antibody response in previously nonimmunised recipients. Goal: Identify a method to detect previous immunisation in at-risk patients with CDC negative XM. Methods: All female transplant candidates with a negative CDC XM and children from their potential donors were regarded to have an immunological risk. They received a total of 3 DST from their potential donor and were treated with azathioprin or MMF. Before each DST and after the final DST a CDC XM was performed. Samples before and after DST were analysed with Flow Cytometric crossmatch (FCXM) in 16 of 21 transplant candidates. Results: 21 immunologically at-risk transplant candidates received DST. 12 remained CDC XM-negative and were transplanted. No graft loss was observed due to rejection. From the 9 candidates who developed anti-donor Abs (detected by CDC), 4 had a positive FCXM before DST indicating that they had been previously immunised due to pregnancy. These 4 patients developed high PRA as well. Importantly, 2 of the 9 were FCXM negative before DST implying that they had not be sensitised by pregnancy; in these cases, immunisation was likely caused by DST. In the remaining 3 candidates, no FCXM was done. Summary: At least 2 of 21 patients were immunised de novo by DST. The presence of anti donor Abs could have been detected in 4 of 21 candidates by FCXM avoiding the necessity of DST and preventing high PRA. Conclusions: DST is potentially harmful and can wrongly immunise transplant candidates. FCXM in potentially immunised CDC XM negative transplant candidates is safe and identifies patients at-risk for hyper- and peracute-rejection. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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