Anti‐HLA alloantibodies in pediatric solid organ transplantation

Girnita, Alin; Webber, Steven A.; Zeevi, Adriana

doi:10.1111/j.1399-3046.2005.00425.x

Cited by 35 publications

(26 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…18,27 We also found ACR and AMR to be a common problem early post-transplant in our patient population despite aggressive therapy. However, the majority of cases of early AMR and ACR were controlled with intensive immune modulation, and by 6 months post-HTx all cases had resolved.…”

Section: Rejectionmentioning

confidence: 77%

“…27 Other reports in the literature, both adult and pediatric, mirror this finding of a higher incidence of CAV associated with sensitization, a positive donorspecific crossmatch, or AMR. 17,18 Intermediate data showing the lack of CAV development in the majority of our cohort is encouraging but longer follow-up is imperative before drawing any overall conclusions.…”

Section: Graft Vasculopathymentioning

confidence: 97%

“…1,6 Both antibodies to Class I and Class II antigens appear to be related to an elevated risk of rejection. 18 ACR, AMR, and CAV are all associated with a donor specific positive cross-match. 4 -6,13 In particular, anti-Class II antibodies have been linked to an increased incidence of rejection, CAV, and rejection-related mortality.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Pediatric Heart Transplantation in Human Leukocyte Antigen–Sensitized Patients

Pollock-BarZiv

Hollander²,

Ngan³

et al. 2007

Circulation

View full text Add to dashboard Cite

Background— There is an elevated risk for poor outcomes after heart transplant (HTx) in patients sensitized to human leukocyte antigens including graft dysfunction, acute cellular and antibody-mediated (AMR) rejection, and cardiac allograft vasculopathy. We report our experience with human leukocyte antigens–sensitized pediatric HTx recipients. Methods and Results— We identified pediatric HTx patients with elevated pre-HTx Panel Reactive Antibody (Class I/II; >10%), or a positive T- or B-cell crossmatch. Thirteen patients met criteria (5 female, 39%). The median age at HTx was 7 months (3.5 months to 15.5 years). Nine were infants who had prior palliation for congenital heart disease. Four were older patients (median 7.3 years; 4.8 to 15.5 years): 2 had congenital heart disease (Fontan), 2 were re-HTx. B-cell therapies were used in all patients, guided by assessment of CD19+ and CD20+ cells. Immunosuppression included thymoglobulin induction, and tacrolimus, mycophenolate mofetil, and steroids. Daily plasmapheresis ± intravenous immunoglobulin G was used if there was a positive crossmatch on day 1, with a gradual, biopsy-guided weaning schedule. Rituximab was used when AMR was detected on biopsy: more recently (n=3), used empirically perioperatively. AMR was confirmed in 9 patients within median 0.9 months post-HTx. Seven had early acute cellular rejection (≥ ISHLT Grade 2 R) with no hemodynamic compromise or graft dysfunction. There were 4 deaths post-HTx (range, 11 days to 9 months). The median follow-up of 9 survivors was 1.7 years (0.3 to 3.7 years). Of 7 patients >6 months post-HTx, no AMR or cardiac allograft vasculopathy was observed at a mean of 1.9+1.1 years post-HTx and no cardiac allograft vasculopathy. Conclusions— Despite aggressive management, acute cellular rejection and AMR occurred frequently early post-HTx. An algorithm of B cell–directed strategies can be effective in managing these patients with reasonable intermediate-term outcomes.

show abstract

Section: Rejectionmentioning

confidence: 77%

Section: Graft Vasculopathymentioning

confidence: 97%

See 1 more Smart Citation

Pediatric Heart Transplantation in Human Leukocyte Antigen–Sensitized Patients

Pollock-BarZiv

Hollander²,

Ngan³

et al. 2007

Circulation

View full text Add to dashboard Cite

show abstract

“…Data on the role of HLAab in children with RTx are so far very limited [19]. The significance of HLA-DSA before RTx has been reported in two studies [20,21], and one study has examined the role of posttransplant HLA-DSA on graft survival [22].…”

Section: Introductionmentioning

confidence: 97%

Donor-specific HLA antibodies and graft function in children after renal transplantation

et al. 2012

View full text Add to dashboard Cite

show abstract

“…As evidence in the pediatric cohort, which includes a large percentage of HLA antibody-negative patients at the time of first transplant, is so far very limited and controversial (15)(16)(17), we analyzed a pediatric cohort of pretransplant HLA-antibody-negative, first kidney recipients for: (i) de novo occurrence of anti-HLA antibodies through a retrospective, systematic evaluation of sequential serum samples; (ii) HLA antigen specificity and function characterization; (iii) relationship of anti-HLA antibody emergence with renal function and graft outcome.…”

Section: Introductionmentioning

confidence: 99%

Posttransplant De Novo Donor-Specific HLA Antibodies Identify Pediatric Kidney Recipients at Risk for Late Antibody-Mediated Rejection

Ginevri

Nocera

Comoli

et al. 2012

American Journal of Transplantation

152

137

View full text Add to dashboard Cite

The emerging role of humoral immunity in the pathogenesis of chronic allograft damage has prompted research aimed at assessing the role of anti-HLA antibody (Ab) monitoring as a tool to predict allograft outcome. Data on the natural history of allografts in children developing de novo Ab after transplantation are limited. Utilizing sera collected pretransplant, and serially posttransplant, we retrospectively evaluated 82 consecutive primary pediatric kidney recipients, without pretransplant donor-specific antibodies (DSA), for de novo Ab occurrence, and compared results with clinical-pathologic data. At 4.3-year follow up, 19 patients (23%) developed de novo DSA whereas 24 had de novo non-DSA (NDSA, 29%). DSA appeared at a median time of 24 months after transplantation and were mostly directed to HLA-DQ antigens. Among the 82 patients, eight developed late/chronic active C4d+ antibody-mediated rejection (AMR), and four C4d-negative AMR. Late AMR correlated with DSA (p < 0.01), whose development preceded AMR by 1-year median time. Patients with DSA had a median serum creatinine of 1.44 mg/dL at follow up, significantly higher than NDSA and Ab-negative patients (p < 0.005). In our pediatric cohort, DSA identify patients at risk of renal dysfunction, AMR and graft loss; treatment started at Ab emergence might prevent AMR occurrence and/or progression to graft failure.

show abstract

Anti‐HLA alloantibodies in pediatric solid organ transplantation

Cited by 35 publications

References 65 publications

Pediatric Heart Transplantation in Human Leukocyte Antigen–Sensitized Patients

Pediatric Heart Transplantation in Human Leukocyte Antigen–Sensitized Patients

Donor-specific HLA antibodies and graft function in children after renal transplantation

Posttransplant De Novo Donor-Specific HLA Antibodies Identify Pediatric Kidney Recipients at Risk for Late Antibody-Mediated Rejection

Contact Info

Product

Resources

About