Evaluation of current strategies for surveillance and management of donor‐specific antibodies: Single‐center study

Sullivan, Daniel C.; Ahn, Chul; Gao, Ang; Lacelle, Chantale; Torres, Fernando; Bollineni, Srinivas; Banga, Amit; Mullins, Jessica; Mohanka, Manish; Ring, W. Steves; Wait, Michael A.; Peltz, Matthias; Duddupudi, Pavan; Surapaneni, Dhiraj; Kaza, Vaidehi

doi:10.1111/ctr.13285

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…For the normal human study, a panel of 20‐40 non‐sensitized sera were tested to establish bead cutoff. This method for calculating bead threshold has previously been published by Sullivan et al…”

Section: Resultsmentioning

confidence: 99%

Allograft outcomes of treated children with kidney transplant who developed plasma cell‐rich acute rejection (PCAR): A single center's experience

Alhamoud

Huang

Lacelle

et al. 2019

Pediatric Transplantation

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Introduction PCAR is a rare form of ACR that may compromise renal allografts. This review evaluates the outcomes of a protocol used to treat PCAR (Study group), and compares these outcomes with a matched cohort with ACR (Control group). Methods A retrospective analysis of 138 of pRTRs who underwent renal allograft biopsies between January 2008 and November 2016. Results Seven biopsies revealed in situ hybridization of EBER‐negative PCAR (5%). Three Study group pRTRs lost their grafts within 3 months after rejection (43%). None of the Control group pRTRs lost their graft during this period. At the time of rejection, eGFR was different between the Control and Study groups (27.0 ± 19.9 mL/min per m2 vs 40.0 ± 10.6 mL/min/1.73 m2, respectively; P < 0.05). Among Study group pRTRs with functioning allografts (n = 4), treatment resulted in an increase in eGFR from nadir levels (27.0 ± 19.9 vs 55.6 ± 18.3 mL/min/1.73 m2, P < 0.05). In the Study group, complications included neutropenia, BK and EBV viremia, and infusion‐related hypotension and hypertension. Summary (a) Graft loss in Study group while remaining high (43%) was lower than that reported in the published pediatric literature. (b) Our protocol was associated with improvement in eGFR in all surviving pRTRs within the Study group. (c) No life‐threatening complications or malignancy were reported during the observation period.

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Section: Resultsmentioning

confidence: 99%

Allograft outcomes of treated children with kidney transplant who developed plasma cell‐rich acute rejection (PCAR): A single center's experience

Alhamoud

Huang

Lacelle

et al. 2019

Pediatric Transplantation

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“…First, the number of LTX recipients is still in short for analysis. Despite the transplant circumstance changing in Japan, the shortage of organ donors is one of the largest issues in all solid organ transplantation [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Analysis was done in sensitized vs non-sensitized recipients, rather than positive vs negative DSA, due to the small sample number.…”

Section: Discussionmentioning

confidence: 99%

“…Even fewer recipients had DSA (5.4%, 5/93), which was far lower than that of other transplant facilities, e.g. over 80% of 320 lung transplant recipients were sensitized and around a half had developed DSA within 2 years post-transplantation in Toronto, Canada [ 2 ], 50.1% (105/206) of recipients transplanted within a year had DSA in Suresnes, France [ 3 ] and 63.9% (124/194) in LTRs developed DSA in Dallas, United States [ 13 ]. However, the data shown in this study is a snapshot of a single and often remote time point from the LTX operation.…”

Section: Discussionmentioning

confidence: 99%

The fraction of sensitization among lung transplant recipients in a transplant center in Japan

et al. 2020

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Background Anti-human leukocyte antigen (HLA) antibody testing was approved by the Japanese government in 2018. As such, there was no longitudinal data regarding the HLA-sensitization of lung transplant (LTX) patients in Japan. We therefore set out to measure anti-HLA antibodies from all our LTX patients during their annual follow-up to characterize the sensitization status in the Japanese population. Methods The cross-sectional study was conducted for consecutive LTX recipients who underwent transplantation from January 2000 to January 2020 at Tohoku University Hospital (TUH). The serum from the recipients was screened for anti-HLA antibody with the panel-reactive assay (PRA) and the donor-specific antibodies (DSA). Results Sensitization was reviewed in 93 LTX recipients, showing 23 positive (24.7%) and 70 negative (75.3%) PRA. More sensitized recipients were found in recent transplantations (60.9% (14/23), ≤5 years post LTX) than in older transplantations (17.4% (4/23), 5–10 years or 21.7% (5/23), ≥10 years post LTX) (p = 0.04). Even fewer recipients had DSA (5.4%, 5/93), among whom 4/5 (80%) were recently transplanted. Conclusion The rate of PRA positive LTX recipients in our population was lower compared with those in previous reports from US and Europe. More sensitized LTRs were found in recent transplantations than the older cohort, and DSA was identified primarily in the recent recipients. Due to several limitations, it is still unclear whether the sensitization would be related the development of CLAD or survival, yet this study would be fundamental to the future anti-HLA body study in Japanese population.

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“…When dnDSAs were found without evidence of rejection, patients were given a higher dose of immunosuppression (tacrolimus and mycophenolate mofetil) as well as immunoglobulins. 28 In recipients with confirmed AMR, the immunosuppression treatment was also increased, including plasmapheresis and rituximab. The demographic, clinical, and immunologic parameters of LTR are summarized in Table 1 .…”

Section: Methodsmentioning

confidence: 99%

DQA1 Eplet Mismatch Load As an Independent Risk Factor of CLAD After Lung Transplantation

González-López

Cuesta

Roa-Bautista

et al. 2023

Transplantation Direct

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Background. Lung transplantation remains the treatment of choice for end-stage lung diseases, and recipient selection is currently based on clinical urgency, ABO compatibility, and donor size. The risk of allosensitization is classically based on HLA mismatch, but eplet mismatch load is increasingly seen to be important in long-term outcomes in solid organ transplantation. Chronic lung allograft dysfunction (CLAD) is relatively common and relevant, affecting almost 50% of patients 5 y after transplantation and being the first cause of death from the first year after transplantation. The overall class-II eplet mismatch load has been associated with CLAD development. Methods. Based on clinical data, 240 lung transplant recipients were eligible for CLAD, and HLA and eplet mismatch was analyzed using the HLAMatchmaker 3.1 software. Results. A total of 92 (38.3%) lung transplant recipients developed CLAD. The time free-of-CLAD was significantly decreased in patients with presence of DQA1 eplet mismatches (P = 0.015). Furthermore, when other previously described CLAD risk factors were studied in a multivariate analysis, the presence of DQA1 eplet mismatches was found to be independently associated with the early onset of CLAD. Conclusions. The concept of epitope load has arisen as a new tool to better define donor–recipient immunologic compatibility. The presence of DQA1 eplet mismatches potentially would increase the likelihood of developing CLAD.

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Evaluation of current strategies for surveillance and management of donor‐specific antibodies: Single‐center study

Cited by 6 publications

References 29 publications

Allograft outcomes of treated children with kidney transplant who developed plasma cell‐rich acute rejection (PCAR): A single center's experience

Allograft outcomes of treated children with kidney transplant who developed plasma cell‐rich acute rejection (PCAR): A single center's experience

The fraction of sensitization among lung transplant recipients in a transplant center in Japan

DQA1 Eplet Mismatch Load As an Independent Risk Factor of CLAD After Lung Transplantation

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