Efficacy of tacrolimus in ABO-incompatible kidney transplantation: clinicopathological aspect of humoral rejection

Saito, Kazuhide; Nakagawa, Yuki; Tanikawa, Toshiki; Sonda, K; Nishi, S; Yamaguchi, Y; Arakawa, Masaaki; Takahashi, K

doi:10.1016/s0041-1345(99)00588-6

Cited by 9 publications

(3 citation statements)

References 1 publication

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“…Tacrolimus is 50-to 100fold more potent and selective than cyclosporine at inhibiting T-cell activation, down-regulating cytokines such as interleukin 2 (IL-2), IL-3, and IL-4, and directly blocking cell division and proliferation of activated B cells, thereby preventing cellular and humoral rejection. 25,26 Mycophenolate mofetil is a more potent antimetabolite compared to azathioprine and suppresses the differentiation and proliferation of active plasma cells and thus inhibiting the production of immunoglobulin. A recent double-blind study of 86 heart transplant recipients taking mycophenolate mofetil or azathioprine demonstrated favorable suppression by mycophenolate mofetil of an antiendothelial antibody associated with the development of posttransplant coronary artery disease.…”

Section: Postoperative Immunosuppressionmentioning

confidence: 99%

Pediatric Heart Transplantation across ABO Blood Type Barriers: A Case Study

et al. 2005

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Heart transplantation with ABO blood type-incompatible donors has historically been contraindicated because of the high risk of an immediate hyperacute humoral graft rejection. The immature neonatal immune system presents an immunologic window that allows for breaching the ABO barrier before the natural development of anti-ABO antibodies. Information from a small series of neonates has demonstrated similar survival rates and posttransplant outcomes compared to ABO-compatible transplantations. In the posttransplant period, particular attention is placed on the surveillance of graft-specific antibody production and monitoring for immunologic signs and symptoms of early graft vasculopathy. This article presents a case study of a neonate with congenital heart disease who underwent one of the first successful ABO-incompatible heart transplantations in the United States.

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Section: Postoperative Immunosuppressionmentioning

confidence: 99%

Pediatric Heart Transplantation across ABO Blood Type Barriers: A Case Study

et al. 2005

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“…Wiemer et al [19] demonstrated enhanced monocyte responses in renal transplant recipients after switching from cyclosporine to tacrolimus. Their findings could help explain our observations that question the superiority of tacrolimus over cyclosporine in AHR [20,21].…”

Section: Discussionmentioning

confidence: 76%

Plasmapheresis as rescue therapy in accelerated acute humoral rejection

Abraham

Brown

Conlon

et al. 2003

J of Clinical Apheresis

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Accelerated acute humoral rejection (AHR) continues to occur in renal transplantation despite improved crossmatching, with potentially devastating consequences. Between 1 June 1998 and 31 December 2000, 440 renal transplants were performed in our center. AHR was diagnosed by the demonstration of typical pathological features on renal histology and positive direct immunofluorescence or detection of anti-HLA antibodies in serum. AHR developed in 20 (4.5%) of our renal transplant recipients, nine male and eleven female at an average of 16.3 days post transplantation. All of these patients had a negative current cytotoxic crossmatch prior to transplantation. The median serum creatinine at diagnosis was 5.96 mg/dL, and 83% of these individuals developed oliguric renal failure requiring dialysis after having initially attained good graft function (median of best serum creatinine before AHR was 2.64 mg/dL). The 18 recipients who had not infarcted their grafts at the time of diagnosis of AHR received plasmapheresis in conjunction with intensification of their immunosuppressive regimen. This regimen was successful in reversing AHR in 78% of those treated with apheresis. In the 14 responders, graft survival at 6 months was 100% and at 12 months was 91%. Median serum creatinine at 6 and 12 months was 1.26 and 1.33 mg/dL, respectively. Patients received an average of 8.1 plasma exchanges. However, responders received a significantly higher frequency of plasmapheresis (P =.0053), despite undergoing a similar number of exchanges overall. Plasmapheresis appears to be an effective modality for reversing AHR and maintaining graft function.

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“…There are five pillars of immunosuppressive therapy for ABO‐incompatible kidney transplantation. Those are (i) extracorporeal immunomodulation by means of anti‐A and B antibody removal, (ii) pharmacotherapy for T‐ and B‐cell inhibition, (iii) splenectomy or suppression of antibody production with anti‐CD20 monoclonal antibody (rituximab), (iv) anticoagulation therapy, and (v) inducing accommodation (5–7, 23–30).…”

Section: Immunosuppressive Therapy and Induction Of Accommodation In mentioning

confidence: 99%

A new concept of accommodation in ABO‐incompatible kidney transplantation

Takahashi

2005

Clinical Transplantation

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This work focuses on the mechanism of acute antibody-mediated rejection leading to graft loss and the mechanisms of accommodation permitting graft survival in ABO-incompatible kidney transplantation. As previously noted, accommodation occurs only with (i) post-transplant suppression of glycosyltransferase, a product of ABO histo-blood group genes in the graft and (ii) prevention of antigen-antibody reactions and delayed hyperacute rejection due to reduced antigenicity of enzyme-regulated histo-blood group antigens. This article discusses the mechanism of ABO histo-blood group glycosyltransferase suppression. Accommodation is always established in successful ABO-incompatible organ grafts and ABO-minor mismatch bone marrow transplantation. In the former, accommodation develops even though ABO histo-blood types of the recipient and the donor are incompatible. In the latter, infusion of donor-derived bone marrow causes the recipient's blood to be eventually replaced by blood of the donor's type. However, the recipient's organs retain their original tissue type. In successful bone marrow engraftment, accommodation is established regardless of ABO-incompatibility. In organ transplantation the recipient's ABO histo-blood type regulates the graft's ABO histo-blood type, while in bone marrow transplantation the new ABO histo-blood type from the donor suppresses and regulates the ABO histo-blood type in recipient organs. In other words, bone marrow-derived histo-blood type regulates the histo-blood type of the organs.

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Efficacy of tacrolimus in ABO-incompatible kidney transplantation: clinicopathological aspect of humoral rejection

Cited by 9 publications

References 1 publication

Pediatric Heart Transplantation across ABO Blood Type Barriers: A Case Study

Pediatric Heart Transplantation across ABO Blood Type Barriers: A Case Study

Plasmapheresis as rescue therapy in accelerated acute humoral rejection

A new concept of accommodation in ABO‐incompatible kidney transplantation

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