HLA Class I Sensitization in Islet Transplant Recipients: Report from the Collaborative Islet Transplant Registry
| Autor: | Franca B. Barton, Bashoo Naziruddin, Rodolfo Alejandro, Michael R. Rickels, D. Stablein, S Wease, Thierry Berney |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Graft Rejection
Adult Male endocrine system Isoantibodies/immunology medicine.medical_treatment Islets of Langerhans Transplantation Biomedical Engineering lcsh:Medicine Human leukocyte antigen Article Isoantibodies Transplantation Homologous/immunology Histocompatibility Antigens Class I/immunology/metabolism Transplantation Homologous Humans Medicine Registries Sensitization Alleles Class (computer programming) Transplantation Type 1 diabetes geography geography.geographical_feature_category ddc:617 business.industry Histocompatibility Testing Histocompatibility Antigens Class I lcsh:R Panel reactive antibody Immunosuppression Cell Biology Graft Rejection/immunology Middle Aged medicine.disease Islet Diabetes Mellitus Type 1 medicine.anatomical_structure Immunology Female Pancreatic islet transplantation Diabetes Mellitus Type 1/therapy business |
| Zdroj: | Cell Transplantation, Vol. 21, No 5 (2012) pp. 901-8 Cell Transplantation, Vol 21 (2012) |
| ISSN: | 1555-3892 0963-6897 |
| Popis: | Pancreatic islet transplantation is a promising treatment option for patients severely affected with type 1 diabetes. This report from CITR presents pre- and posttransplant human leukocyte antigen (HLA) class I sensitization rates in islet-alone transplantation. Data came from 303 recipients transplanted with islet-alone between January 1999 and December 2008. HLA class I sensitization was determined by the presence of anti-HLA class I antibodies. Panel-reactive antibodies (PRA) from prior to islet infusion and at 6 months, and yearly posttransplant was correlated to measures of islet graft failure. The cumulative number of mismatched HLA alleles increased with each additional islet infusion from a median of 3 for one infusion to 9 for three infusions. Pretransplant PRA was not predictive of islet graft failure. However, development of PRA >20% posttransplant was associated with 3.6-fold ( p < 0.001) increased hazard ratio for graft failure. Patients with complete graft loss who had discontinued immunosuppression had significantly higher rate of PRA ≥ 20% compared to those with functioning grafts who remained on immunosuppression. Exposure to repeat HLA class I mismatch at second or third islet infusions resulted in less frequent development of de novo HLA class I antibodies when compared to increased class I mismatch. The development of HLA class I antibodies while on immunosuppression is associated with subsequent islet graft failure. The risk of sensitization may be reduced by minimizing the number of islet donors used per recipient, and in the absence of donor-specific anti-HLA antibodies, repeating HLA class I mismatches with subsequent islet infusions. |
| Databáze: | OpenAIRE |
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