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Clinical Transplants

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https://www.readbyqxmd.com/read/26281152/the-role-of-hla-antibodies-in-hla-mismatched-allogeneic-hematopoietic-stem-cell-transplantation
#1
Xian Zhang, Jianling Wang, Zaitong Zhou, Yang Zhang, Hongxing Liu, Chunrong Tong, Caoxing Yu, Yue Lu, Yanli Zhao, Min Xiong, Jia Rui Zhou, Sunrui Juan, De Yan Liu, Zhijie Wei, Jianping Zhang, Tong Wu, Dao-Pei Lu
Published reports suggest that engraftment failure after hematopoietic stem cell transplantation (HSCT) is closely associated with the presence of donor-specific HLA antibodies (DSA). Herein, we report a single cohort retrospective analysis of 567 cases of HLA mismatched allogeneic HSCT patients from the Lu Dao-pei Hematology Center, transplanted between September 11, 2012, and November 20, 2014. Of these cases, 306 patients underwent HLA class I and II antibody testing within one month before transplantation...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281151/allo-hematopoietic-stem-cell-transplant-in-china-2014-update
#2
REVIEW
Meng Lv, Xiao-Jun Huang
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) provides powerful curative weapons for patients with certain hematological diseases. Great improvements have been made within recent years, particularly in the fields of haploidentical HSCT, allo-HSCT for aplastic anemia, and strategies to overcome relapse and graft versus host disease. This review updates the current state of allo-HSCT in China.
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281150/early-de-novo-donor-specific-antibody-involvement-in-delayed-graft-function-after-kidney-transplantation-a-report-of-2-cases
#3
Lan Zhu, Gang Chen, Weijie Zhang, Hui Guo, Zhengbin Lin, Dunfeng Du, Song Chen, Huibo Shi, Shenwei Liu, Zhishui Chen
Kidney tubular damage caused by ischemia-reperfusion injury is considered the major cause of delayed graft function (DGF) after renal transplantation. It is not clear whether early generated de novo donor specific antibodies (DSA) play a role in DGF. Here, we report 2 cases of renal transplant with DGF, which seems to be associated with de novo DSA. When the early produced de novo DSA are not potent enough to mediate acute rejection, they may cause mild intra-graft injury, which has a significant impact on the degree of DGF and its recovery...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281149/treatment-of-biopsy-proven-acute-antibody-mediated-rejection-using-thymoglobulin-atg-monotherapy-and-a-combination-of-rituximab-intravenous-immunoglobulin-and-plasmapheresis-lesson-learned-from-primary-experience
#4
Jin Zheng, Wujun Xue, Xin Qing, Xin Jing, Jun Hou, Xiaohui Tian, Qi Guo, Xiaoli He, Junchao Cai
BACKGROUND: Three strategies have been previously proposed to treat or prevent antibody-mediated rejection (AMR): (1) inhibition/depletion of antibody producing cells; (2) removal/blockage of antibodies; and, (3) inhibition of antibody-mediated tissue injury. Here we test the efficacy of lymphocyte-depleting agent antithymocyte globulin (ATG) and triple therapy of rituximab, intravenous immunoglobulin (IVIG), and plasmapheresis in treating AMR. MATERIALS AND METHODS: Five biopsy-proven AMR patients were enrolled in this acute AMR treatment study...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281148/combination-of-total-lymphoid-irradiation-low-dose-ivig-and-atg-as-rescue-therapy-for-highly-sensitized-and-antibody-mediated-rejection-renal-transplant-recipients
#5
Dong Zhu, Guisheng Qi, Qunye Tang, Long Li, Cheng Yang, Miao Lin, Boting Wu, Ming Xu, Junchao Cai, Tongyu Zhu, Ruiming Rong
UNLABELLED: Background: It is now clear that antibody- mediated rejection (AMR) is a major cause of graft failure. To avoid AMR, transplantation is preferably performed in non- or low-sensitized patients. For patients with pre-existing HLA antibodies due to pre-transplant sensitization or those with de novo HLA antibodies due to transplantation, elimination or reduction of HLA antibodies becomes critical to prevent AMR. Materials and Methods: In this clinical trial, we test the efficacy of a combination therapy of total lymphoid irradiation (TLI), low- dose intravenous immunoglobulin (IVIG), and anti-thymocyte globulin (ATG) with or without plasmapheresis (PP) in treating patients with HLA antibodies...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281147/higher-serum-trough-levels-of-tacrolimus-increase-5-year-allograft-survival-in-antibody-positive-renal-transplant-patients
#6
Zhi-Guo Peng, Jun Tian
BACKGROUND: The presence of human leukocyte antigen (HLA) and major histocompatibility complex class I chain-related gene-A (MICA) antibodies after transplantation is correlated with rejection episodes, proteinuria, and renal allografts loss. We assessed the clinical value of high-dose tacrolimus on post-transplant HLA and MICA antibodies and proteinuria after renal transplantation. METHODS: Post-transplant sera of 310 renal transplantation patients who were negative for antibodies prior to transplant were tested by Luminex flow cytometry for HLA antibodies and MICA antibodies posttransplant...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281146/early-intervention-in-living-kidney-transplantation-based-on-dynamic-monitoring-of-donor-specific-antibodies
#7
Yu Chen, Lang-Yan Li, Xiao-Yan Lou, Hao Wang, Lei Zhang, You-Hua Zhu
This study aims to analyze the clinical application of HLA donor specific antibodies (DSA) detected by Luminex single antigen beads and to discuss the impact of early intervention on renal function in DSA positive kidney transplant patients. In 64 cases of living-related renal transplantation, DSA was detected using Luminex single antigen bead assays before and after transplantation. The positive recipients were given intravenous immunoglobulin (IVIG) and increased doses of mycophenolate mofetil (MMF). The relationship between DSA and renal function was analyzed...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281145/effects-of-two-preemptive-post-transplant-desensitization-regimens-upon-renal-allograft-survival-and-dsa-elaboration
#8
Pamela M Kimball, Felecia A McDougan, Anne King
We used a simple point-based algorithm to identify patients who might benefit from desensitization because of their higher risk of antibody-mediated chronic rejection and graft failure. Points were assigned to known but easily determined risk factors (panel reactive antibody, flow crossmatch, delayed graft function) and calculated immediately after deceased donor kidney transplantation. Point totals were used to identify: 1) which patients would receive desensitization; and, 2) which regimen each patient would receive...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281144/late-antibody-mediated-rejection-in-a-large-prospective-cross-sectional-study-of-kidney-allograft-recipients-preliminary-results-of-the-screening-phase-of-the-borteject-trial
#9
RANDOMIZED CONTROLLED TRIAL
Farsad Eskandary, Gregor Bond, Heinz Regele, Nicolas Kozakowski, Zeljko Kikić, Markus Wahrmann, Helmuth Haslacher, Rainer Oberbauer, Vido Ramassar, Philip Halloran, Georg A Böhmig
There is limited data on the rate of late antibody-mediated rejection (ABMR) in unselected transplant cohorts. Here, we investigated the prevalence and characteristics of ABMR in a large cohort of long-term kidney allograft recipients. Patients were screened in the context of a randomized controlled trial (BORTEJECT study; ClinicalTrials.gov: NCT01873157) designed to investigate the impact of bortezomib on the course of late ABMR. The study (initiation in October 2013) includes a cross-sectional ABMR screening (key inclusion criterion: functioning graft at ≥ 180 days) to identify 44 recipients eligible for inclusion in the intervention trial...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281143/beyond-criteria-and-definitions-outcome-of-a-standardized-antibody-mediated-rejection-protocol-with-a-diagnostic-schema-different-from-the-banff-2009-criteria
#10
TrisAnn Rendulic, Daniel S Ramon, Paul D Killen, Milagros Samaniego-Picota, Jeong M Park
A new clinical diagnostic schema is needed for the diagnosis of antibody-mediated rejection (AMR) in kidney transplant recipients due to the limited utility of C4d staining, lack of standardized quantitative tests for donor specific antibodies, and potential new diagnostic markers. The treatment of AMR remains controversial because previous studies included heterogeneous treatment modalities, small sample sizes, and short follow-up time. At the University of Michigan Transplant Center, 26 patients were diagnosed with AMR based on our diagnostic protocol including C4d-negative AMR in thesetting of graft dysfunction and Banff tissue injury type II (capillaritis) or type III (arteritis)...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281142/highly-sensitized-patients-miami-transplant-institute-experience
#11
Adela D Mattiazzi, Alexandra Centeno, Alexandra Amador, Casiana Fernandez-Bango, Catherine Dillard Scowby, Marian O'Rourke, Tamieka Hill-Matthie, Ronak Patel, Frances Barrios, Phillip Ruiz, Linda Chen, Junichiro Saghesima, Gaetano Ciancio, George W Burke, Michael Goldstein, Jayanthi Chandar, Gabriel Contreras, David Roth, Warren Kupin, Giselle Guerra, Rodrigo Vianna
BACKGROUND: Transplantation continues to be challenging in highly sensitized patients. Herein, we compared induction immunosuppression (IS) based on immunologic risk stratification and desensitization with intravenous immunoglobulin (IVIG). METHODS: Of the 42 highly sensitized kidney and 3 kidney-pancreas transplant recipients who underwent IVIG for desensitization from 2008-2014, 10 (Control group) received standard induction IS with antithymocyte globulin, basiliximab, and methylprednisolone, and 35 (Rituximab group) received standard IS with rituximab ± IVIG ± plasmapheresis...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281141/high-dose-intravenous-immunoglobulin-therapy-for-donor-specific-antibodies-in-kidney-transplant-recipients-with-acute-and-chronic-graft-dysfunction-updates-on-previously-reported-cohorts
#12
Javier Alfonso, Jane Gralla, Patrick Klem, Laurence Chan, Alexander C Wiseman, James E Cooper
Kidney allograft damage resulting from donor-specific anti-HLA antibody (DSA) activity has been identified as a key component of long-term graft attrition. DSA that persists following acute antibody-mediated rejection (AMR) episodes and/or DSA associated with chronic graft dysfunction have been shown to be particularly pathogenic. Despite the significantly negative effects of DSA on graft survival, there are currently no accepted treatment modalities. We have previously reported our experience using a regimen of high-dose (5 mg/kg) intravenous immunoglobulin (IVIG) treatment over 6 months for kidney recipients with detectable DSA either following an acute AMR episode or in association with chronic graft dysfunction...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281140/the-role-of-donor-specific-antibodies-in-intestinal-transplantation-experience-at-the-university-of-california-los-angeles-and-literature-review
#13
REVIEW
Elaine Y Cheng, Hugo Kaneku, Douglas G Farmer
Intestinal transplantation is a viable treatment strategy for patients with irreversible intestinal failure for whom parenteral nutrition is no longer an option. Although improvements have been made in short-term post-transplant survival outcomes, long-term allograft loss, mainly to acute or chronic rejection, remains a major obstacle to successful transplantation. In all types of solid organ transplants, there is increasing evidence that antibodies directed against human leukocyte antigens, and in particular donor-specific antibodies (DSA), contribute to acute and chronic rejection as well as allograft loss...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281139/impact-of-donor-specific-hla-antibody-monitoring-after-kidney-transplantation
#14
Swati Rao, Mythili Ghanta, Iris J Lee, Avrum Gillespie, Hemant K Parekh, Steven S Geier, Xu Zeng, Andreas Karachristos, Kwan N Lau, Sunil Karhadkar, Antonio Di Carlo, Nicole M Sifontis, Serban Constantinescu
Kidney transplantation (KT) recipients with donor specific HLA antibodies (DSA) encounter higher rates of acute rejection and inferior allograft survival. We report our single center experience with prospective DSA monitoring and provide details of treatments utilized to overcome the potential impact of DSA in a cohort of predominantly African American adult KT recipients. Seventy-five flow crossmatch negative KT recipients underwent periodic screening for DSA utilizing the single antigen bead assay at 3, 6, 9, and 12 months post-transplant...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281138/improved-long-term-survival-in-kidney-transplant-recipients-with-donor-specific-hla-antibodies-after-mycophenolic-acid-escalation
#15
Lorita M Rebellato, Karen Parker, Matthew J Everly, Kimberly P Briley, William Kendrick, Scott Kendrick, Carl E Haisch, Paul I Terasaki, Paul Bolin
The development of donor specific antibodies (DSA) post transplant has been associated with chronic rejection and graft failure. In a longitudinal study, we have shown that increases in DSA precede rejection by months, thus allowing time for intervention. We hypothesized that mycophenolic acid (MPA) dose increases may reduce and/or stabilize DSA strength and also preserve renal function. Thirty stable DSA positive kidney transplant recipients participated in this Institutional Review Board approved, exploratory, open-label, single center study to assess the efficacy of MPA dose escalation in patients with DSA...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281137/the-virtual-crossmatch-an-essential-tool-for-transplanting-sensitized-patients
#16
REVIEW
Annette M Jackson
Improved virtual crossmatch assessments following the implementation of solid phase HLA antibody immunoassays has significantly impacted transplantation of sensitized candidates, using either deceased or living donor organs. In deceased donor transplants, the virtual crossmatch has reduced the number of unexpected positive crossmatch tests resulting in improved organ allocation and reduced ischemia and wait times. The virtual crossmatch has also improved access to living donor transplantation by expediting donor evaluation by impacting clinical decisions regarding desensitization, and through implementation of successful kidney paired donation programs...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281136/update-on-alloantibodies-in-solid-organ-transplantation
#17
REVIEW
Matthew J Everly
In the last few years, there have been studies published on serial testing and longitudinal analysis of anti-human leukocyte antigen (anti-HLA) antibodies. The focus of these studies was to determine specific characteristics of the impact of donor specific anti-HLA antibodies (DSA) in organ transplant dysfunction. These publications have led to an increasing concern about DSA and a growing effort to better understand DSA and to develop treatment for patients with DSA. In 2014, several reports were published that either confirm or expand upon both the understanding of the humoral theory and the clinical applications of DSA testing...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281135/renal-transplant-outcomes-in-waitlist-candidates-with-a-previous-inactive-status-due-to-being-temporarily-too-sick
#18
COMPARATIVE STUDY
Napat Leeaphorn, Marcelo S Sampaio, Naowanit Natal, Alireza Mehrnia, Mandana Kamgar, Edmund Huang, Kamyar Kalantar-Zadeh, Bruce Kaplan, Suphamai Bunnapradist
BACKGROUND: In 2003, the United Network for Organ Sharing (UNOS) changed its policy to allow candidates with 'inactive' status to accrue time on the waitlist. In this study, we assessed the transplant outcomes among deceased donor kidney transplant (DDKT) recipients who were temporarily inactive specifically due to medical reason, i.e., being temporarily too sick (reason 7). METHODS: Using the UNOS database, adult DDKT recipients were divided into two groups: those who had never been inactivated (active group) and those with a history of being inactive due to reason 7 (reason 7 group)...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281134/efficacy-of-intravenous-immunoglobulin-in-the-treatment-of-persistent-bk-viremia-and-bk-virus-nephropathy-in-renal-transplant-recipients
#19
Tariq Shah, Don Vu, Robert Naraghi, Annabelle Campbell, David Min
BK virus associated nephropathy (BKVN) can cause clinically significant viral infections in renal transplant recipients, leading to allograft dysfunction and loss. The usual management of BKVN involves reduction of immunosuppression and the addition of leflunomide, quinolones, and cidofovir, but the rate of graft loss remains high. The aim of this study was to assess the impact of treatment with intravenous immunoglobulin (IVIG) on the outcome of BKVN in renal transplant recipients. Upon diagnosis of BKVN, patients remained on anti-polyomavirus treatment consisting of reduction of immunosuppression and the use of leflunomide therapy...
2014: Clinical Transplants
https://www.readbyqxmd.com/read/26281133/the-alfred-hospital-lung-transplant-experience
#20
Miranda A Paraskeva, Glen P Westall, David Pilcher, David McGiffin, Bronwyn J Levvey, Trevor J Williams, Gregory I Snell
The management of patients undergoing lung transplantation has continued to evolve, leading to improvements in 90-day and 1-year survival. The significant advancements in donor management and utilization at our center have led to significant increases in lung transplant activity without any compromise in recipient outcomes. Through the use of a patient-centered multidisciplinary model of care involved in all aspects of recipient management, from assessment and waitlisting to pre-, peri- and post-operative care, our lung transplant outcomes represent 2015 world's best lung transplant practice...
2014: Clinical Transplants
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