Donor-directed MHC class I antibody is preferentially cleared from sensitized recipients of combined liver/kidney transplants
| Autor: | Robert A. Bray, Avinash Agarwal, Howard M. Gebel, Stuart J. Knechtle, Wasim A. Dar, C. Watkins, Thomas C. Pearson, K. E. Kokko |
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| Rok vydání: | 2011 |
| Předmět: |
Graft Rejection
Urinary system Genes MHC Class II Genes MHC Class I Histocompatibility Testing Antibody Specificity Isoantibodies MHC class I medicine Immunology and Allergy Humans Transplantation Homologous Pharmacology (medical) Sensitization Retrospective Studies Transplantation Kidney MHC class II biology business.industry Graft Survival Kidney Transplantation Tissue Donors Liver Transplantation body regions medicine.anatomical_structure Immunology biology.protein Antibody business |
| Zdroj: | American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 11(4) |
| ISSN: | 1600-6143 |
| Popis: | For patients with chronic renal and liver diseases, simultaneous liver and kidney transplantation (SLKT) is the best therapeutic option. The role of a pretransplant donor-specific antibody (DSA) in SLKT is unclear. We report the results of a retrospective review from 7/08 to 10/09 of SLKT at our institution. Monitoring of DSA was performed using single antigen bead assay. Between 7/08 and 10/09, there were six SLKT who had preformed DSA and positive XM (four class I and II DSA, one class I DSA only, one class II only). One-year patient and renal graft survival was 83%. Death-censored liver allograft survival was 100%. Acute humoral rejection (AHR) of the kidney occurred in 66% (three with both class I and II DSA and one with only class II DSA) of patients. In those with AHR, class I antibodies were rapidly cleared (p < 0.01) while class II antibodies persisted (p = 0.25). All patients who had humoral rejection of their kidney had preformed anticlass II antibodies. Liver allografts may not be fully protective of the renal allograft, especially with pre-existing MHC class II DSA. Long-term and careful follow-up will be critical to determine the impact of DSA on both allografts. |
| Databáze: | OpenAIRE |
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