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calculated panel reactive antibodies

S Tafulo, J Malheiro, L Dias, C Mendes, E Osório, L S Martins, J Santos, S Pedroso, M Almeida, A Castro-Henriques
The impact of patient's biological differences in waiting time for kidney transplantation is well known and has been a subject of extensive debate and struggle in transplantation community. Our purpose was to evaluate patient's access to kidney transplantation in Portugal, regarding their degree of allosensitization and blood type. A retrospective cohort study including 1020 candidates for kidney transplantation between 01 January 2010 and 31 December 2011 in transplant unit Centro Hospitalar do Porto was performed...
November 2016: HLA
F Torlak, M U S Ayvaci, M E Ahsen, C Arce, M A Vazquez, B Tanriover
BACKGROUND: On December 4, 2014, a new deceased donor kidney allocation system (KAS) was implemented. The KAS was designed to improve organ equity and graft-recipient longevity matching. However, estimated wait-time to deceased donor transplantation is difficult to predict post-KAS. METHODS: Using the Kidney-Pancreas Simulated Allocation Model software (KPSAM), a program that the Organ Procurement and Transplant Network uses to assess policy proposals, we compared the kidney allocations of both the new (post-KAS) and old policies (pre-KAS) (10 iterations for each group; total N = 204,148) and estimated wait-time based on blood type, duration of dialysis exposure, and calculated panel-reactive antibody (CPRA)...
July 2016: Transplantation Proceedings
Manuel A Moreno Gonzales, Manish J Gandhi, Carrie A Schinstock, Natalie A Moore, Byron H Smith, Nong Y Braaten, Mark D Stegall
BACKGROUND: We previously showed that bortezomib (BTZ) partially depletes plasma cells, yet has limited efficacy for desensitization in kidney transplant candidates when up to 16 doses is given. METHODS: This study aimed to determine the safety and efficacy of 32 doses of BTZ (1.3 mg/m of body surface area) in 10 highly sensitized kidney transplant candidates with alloantibodies against their intended living donor. RESULTS: Dose reduction was needed in 2 patients and 2 others completely discontinued therapy for adverse events...
July 1, 2016: Transplantation
Ryan Butts, Melanie Davis, Andrew Savage, Ali Burnette, Minoo Kavarana, Scott Bradley, Andrew Atz, Paul J Nietert
BACKGROUND: The use of induction therapy in pediatric heart transplantation has increased. The aim of this study was to investigate the effects of induction therapy on graft survival. METHODS: The United Network for Organ Sharing database was queried for isolated pediatric heart transplants from January 1, 1994, to December 31, 2013. Propensity scores for induction treatment were calculated by estimating probability of induction using a logistic regression model...
June 29, 2016: Transplantation
Byung-Soo Ko, Stavros Drakos, Abdallah G Kfoury, Denise Hurst, Gregory J Stoddard, Carrie A Willis, Julio C Delgado, Elizabeth H Hammond, Edward M Gilbert, Rami Alharethi, Monica P Revelo, Jose Nativi-Nicolau, Bruce B Reid, Stephen H McKellar, Omar Wever-Pinzon, Dylan V Miller, David D Eckels, James C Fang, Craig H Selzman, Josef Stehlik
BACKGROUND: Immune allosensitization can be triggered by continuous-flow left ventricular assist devices (CF LVAD). However, the effect of this type of allosensitization on post-transplant outcomes remains controversial. This study examined the post-transplant course in a contemporary cohort of patients undergoing transplantation with and without LVAD bridging. METHODS: We included consecutive patients who were considered for cardiac transplant from 2006 to 2015...
August 2016: Journal of Heart and Lung Transplantation
Allyson Hart, Nicholas Salkowski, Jon J Snyder, Ajay K Israni, Bertram L Kasiske
BACKGROUND: Median historical time to kidney transplant is misleading because it does not convey the competing risks of death or removal from the waiting list. We developed and validated a competing risk model to calculate likelihood of outcomes for kidney transplant candidates and demonstrate how this information differs from median time to transplant. METHODS: Data were obtained from the US Scientific Registry of Transplant Recipients. The retrospective cohort included 163 636 adults listed for kidney transplant before December 31, 2011...
July 2016: Transplantation
J W In, E Y Roh, S Shin, K U Park, E Y Song
BACKGROUND: Calculated panel reactive antibody (cPRA) (%) is percentage of donors that would be incompatible with the candidate, based on the candidate's unacceptable HLA antigens. cPRA based on antigen frequencies of HLA-A, B, and DR has been used in Korea. We developed new cPRA including HLA-Cw, DR51/52/53, and DQ. Changes in new-cPRA were evaluated. METHODS: We analyzed the differences between cPRA based on HLA-A, -B, and -DR antigens (old-cPRA) from cPRA based on HLA-A, -B, -Cw, -DR, -DR51/52/53, and -DQ antigens (new-cPRA) on 125 waitlisted candidates for renal transplantation in Seoul National University Hospital...
April 2016: Transplantation Proceedings
Anat R Tambur
PURPOSE OF REVIEW: Recent reports on donor-specific antibodies documented an overwhelming frequency of antibodies to one specific locus - human leukocyte antigen DQ (HLA-DQ). This article provides a short summary of clinical observations, a historic perspective to account for the late recognition of the role of HLA-DQ antibodies as well as potential explanations. RECENT FINDINGS: The basic understanding of the complexity of HLA-DQ molecules (antigens and antibodies) existed already 3-4 decades ago...
August 2016: Current Opinion in Organ Transplantation
Saeid Fathi, Fatemeh Jalousian, Seyed Hossein Hosseini, Hossein Parsa, Somayeh Kordafshari
A standardized test for the serodiagnosis of cystic echinococcosis (CE) remains an important challenge because of the problems in specificity and sensitivity of the available commercial kits and lack of proper evaluation of antigen. Using appropriate sources of antigenic material is crucial in improvement of the serological methods such as enzyme-linked immunosorbent assay (ELISA). This study was conducted to evaluate the performance of protein named Echinococcus protoscolex calcium binding protein EPC1 for the detection of antibodies in sera from patients with CE...
June 1, 2016: American Journal of Tropical Medicine and Hygiene
Julie M Yabu, Janet C Siebert, Holden T Maecker
BACKGROUND: Kidney transplantation is the most effective treatment for end-stage kidney disease. Sensitization, the formation of human leukocyte antigen (HLA) antibodies, remains a major barrier to successful kidney transplantation. Despite the implementation of desensitization strategies, many candidates fail to respond. Current progress is hindered by the lack of biomarkers to predict response and to guide therapy. Our objective was to determine whether differences in immune and gene profiles may help identify which candidates will respond to desensitization therapy...
2016: PloS One
Paolo Ferrari, Linda Cantwell, Joseph Ta, Claudia Woodroffe, Lloyd DʼOrsogna, Rhonda Holdsworth
BACKGROUND: Participation of compatible pairs (CP) in kidney paired donation (KPD) could be attractive to CPs who have a high degree of HLA mismatch, if the CP recipient will gain a better HLA match. Because KPD programs were not designed to help CP, it is important to define allocation metrics that enable CP to receive a better-matched kidney, without disadvantage to incompatible pairs (ICP). METHODS: Simulations using 46 ICPs and 11 fully HLA-mismatched CPs were undertaken using the Australian KPD matching algorithm...
April 13, 2016: Transplantation
Bhanu Mehra, Sonali Bhattar, Shikhar Saxena, Deepti Rawat, Preena Bhalla
BACKGROUND: Serology is considered the mainstay of syphilis diagnosis. The limitations of the traditional serological methods and the advent and availability of novel immunochromatographic assays have led to the widespread application of rapid point-of-care procedures as screening tools for syphilis. However, these tests have not been extensively evaluated. This study was designed to evaluate the performance of a rapid syphilis diagnostic test known as SD BIOLINE Syphilis 3.0 (SD Biostandard Diagnostics Private Limited, Gurgaon, Haryana, India)...
January 2016: Journal of Laboratory Physicians
Lee Ann Baxter-Lowe, Anna Kucheryavaya, Dolly Tyan, Nancy Reinsmoen
In 2009 calculated panel reactive antibody (CPRA) replaced PRA as the metric for HLA sensitization in the US kidney allocation system. During the next four years, registrants with at least one unacceptable antigen increased (34-40%) and registrants with ≥98% PRA/CPRA increased from 7% to 9% of the waitlist. These changes were accompanied by a reduction in kidney offers refused for positive crossmatch: 14,137 (1.7%) in 2009 and 3,310 in 2013 (0.4%). Registrants with ≥98% PRA/CPRA had highest rates of refusal but also showed substantial improvement (20% in 2009 vs 8% in 2013)...
May 2016: Human Immunology
Douglas S Keith, Gayle M Vranic
For patients with ESRD, kidney transplant offers significant survival and quality-of-life advantages compared with dialysis. But for patients seeking transplant who are highly sensitized, wait times have traditionally been long and options limited. The approach to the highly sensitized candidate for kidney transplant has changed substantially over time owing to new advances in desensitization, options for paired donor exchange (PDE), and changes to the deceased-donor allocation system. Initial evaluation should focus on determining living-donor availability because a compatible living donor is always the best option...
April 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Howard M Gebel, Bertram L Kasiske, Sally K Gustafson, Joshua Pyke, Eugene Shteyn, Ajay K Israni, Robert A Bray, Jon J Snyder, John J Friedewald, Dorry L Segev
BACKGROUND AND OBJECTIVES: In December of 2014, the Organ Procurement and Transplant Network implemented a new Kidney Allocation System (KAS) for deceased donor transplant, with increased priority for highly sensitized candidates (calculated panel-reactive antibody [cPRA] >99%). We used a modified version of the new KAS to address issues of access and equity for these candidates. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a simulation, 10,988 deceased donor kidneys transplanted into waitlisted recipients in 2010 were instead allocated to candidates with cPRA≥80% (n=18,004)...
March 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Kwanchai Pirojsakul, Dev Desai, Chantale Lacelle, Mouin G Seikaly
BACKGROUND: Data on renal allograft outcome in sensitized children are scarce. We report the clinical courses of four children who received desensitization therapy prior to renal transplantation in our institution. METHODS: Between 2009 and 2011, four pediatric patients with stage 5 chronic kidney disease received desensitization therapy due to: (1) positive donor-specific antibodies (DSA) and/or crossmatches with potential living donors, (2) more than three positive crossmatches with deceased donors or (3) high calculated panel-reactive antibody of >80 %...
October 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
M A Mujtaba, W J Komocsar, E Nantz, M D Samaniego, S L Henson, J A Hague, A L Lobashevsky, N G Higgins, M Czader, B K Book, M D Anderson, M D Pescovitz, T E Taber
B cell-activation factor (BAFF) is critical for B cell maturation. Inhibition of BAFF represents an appealing target for desensitization of sensitized end-stage renal disease (ESRD) patients. We conducted a Phase 2a, single-arm, open-label exploratory study investigating the effect of tabalumab (BAFF inhibitor) in patients with ESRD and calculated panel reactive antibodies (cPRAs) >50%. The treatment period duration was 24 weeks. Eighteen patients received tabalumab, at doses of 240-mg subcutaneous (SC) at Week 0 followed by 120-mg SC monthly for 5 additional months...
April 2016: American Journal of Transplantation
Allan B Massie, Xun Luo, Bonnie E Lonze, Niraj M Desai, Adam W Bingaman, Matthew Cooper, Dorry L Segev
The Kidney Allocation System (KAS), a major change to deceased donor kidney allocation, was implemented in December 2014. Goals of KAS included directing the highest-quality organs to younger/healthier recipients and increasing access to deceased donor kidney transplantation (DDKT) for highly sensitized patients and racial/ethnic minorities. Using national registry data, we compared kidney distribution, DDKT rates for waitlist registrants, and recipient characteristics between January 1, 2013, and December 3, 2014 (pre-KAS) with those between December 4, 2014, and August 31, 2015 (post-KAS)...
August 2016: Journal of the American Society of Nephrology: JASN
Gleidys Davalos-Krebs
Chagas disease is caused by a protozoan named Trypanosoma cruzi transmitted to humans by reduviid bugs. Severe dilated cardiomyopathy from chronic T cruzi infection is the most common finding, leading to end-stage heart failure. Heart transplant is an effective treatment for Chagas heart disease. However, T cruzi reactivation is of great concern, predisposing patients to episodes of myocarditis and rejection. A 56-year-old woman with a history of Chagas disease and elevated calculated panel reactive antibodies (CPRAs) underwent induction therapy and desensitization strategies aimed at lowering CPRAs, as elevated CPRAs have been implicated in the development of antibody-mediated rejection and reduced allograft survival...
December 2015: Progress in Transplantation
J Y Revollo, M C Cuffy, B G Abu Jawdeh, F Paterno, A Girnita, P Brailey, R R Alloway, E S Woodle
BACKGROUND: Highly sensitized patients, who produce antibodies against multiple anti-human leukocyte antigens, have significantly reduced chances for renal transplantation. Traditionally, desensitization protocols to reduce the levels of antibodies have relied on the use of intravenous immunoglobulin and plasmapheresis. RESULTS: Here we report the case of a patient with a calculated panel-reactive antibody level of 100% who was desensitized using multiple courses of bortezomib, a proteasome inhibitor, in an intravenous immunoglobulin-free regimen...
September 2015: Transplantation Proceedings
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