From Donor to Recipient: Current Questions Relating to Humoral Alloimmunization

Prigent, Antoine; Maillard, Nicolas; Absi, Léna; Aloui, Chaker; Cognasse, Fabrice; Laradi, Sandrine; Mariat, Christophe; Garraud, Olivier

doi:10.3390/antib3010130

Cited by 7 publications

(6 citation statements)

References 127 publications

(123 reference statements)

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“…Although not examined in the present study, it is known that IgG subclasses have different C1q-binding affinities, with most potent binding for IgG3 followed by IgG1, which is predominant, very weak binding for IgG2, and no binding for IgG4 [24]. However, the underlying cause of immunization (pregnancy, blood cell transfusion, grafting) was reported to have a low impact on the subclass repartition [25,26]. Therefore, it is supposed that the amounts of IgG, represented by the MFI, mainly influence the interaction with C1q.…”

Section: Discussionmentioning

confidence: 72%

Preformed C1q-binding Donor-specific Anti-HLA Antibodies and Graft Function After Kidney Transplantation

Okabe

Noguchi

Miyamoto

et al. 2018

Transplantation Proceedings

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Background. De novo complement-binding donor-specific anti-human leukocyte antigen antibodies (DSAs) are reportedly associated with an increased risk of kidney graft failure, but there is little information on preformed complement-binding DSAs. This study investigated the correlation between preformed C1q-binding DSAs and medium-term outcomes in kidney transplantation (KT). Methods. We retrospectively studied 44 pretransplant DSA-positive patients, including 36 patients who underwent KT between April 2010 and October 2016. There were 17 patients with C1q-binding DSAs and 27 patients without C1q-binding DSAs. Clinical variables were examined in the 2 groups. Results. Patients with C1q-binding DSAs had significantly higher blood transfusion history (53.0% vs 18.6%; P ¼ .0174), complement-dependent cytotoxicity crossmatch (CDC-XM)-positivity (29.4% vs 0%; P ¼ .0012), and DSA median fluorescence intensity (MFI) (10,974 vs 2764; P ¼ .0009). Among patients who were not excluded for CDC-XM-positivity and underwent KT, there was no significant difference in cumulative biopsy-proven acute rejection rate (32.5% vs 33.5%; P ¼ .8354), cumulative graft survival, and 3-month and 12-month protocol biopsy results between patients with and without C1q-binding DSAs. Although patients with C1q-binding DSAs showed a higher incidence of delayed graft function (54.6% vs 20.0%; P ¼ .0419), multivariate logistic regression showed that DSA MFI (P ¼ .0124), but not C1q-binding DSAs (P ¼ .2377), was an independent risk factor for delayed graft function. Conclusions. In patients with CDC-XM-negativity, preformed C1q-binding DSAs were not associated with incidence of antibody-mediated rejection and medium-term graft survival after KT. C1q-binding DSAs were highly correlated with DSA MFI and CDC-XM-positivity. K IDNEY transplantation (KT) for end-stage renal disease has been associated with substantial reductions in the risk of mortality and cardiovascular events, as well as clinically relevant improvements in quality of life [1]. At the same time, it has been recognized that sensitized renal transplant recipients with high levels of donor-specific antihuman leukocyte antigen antibodies (DSAs) commonly develop antibody-mediated rejection (AMR), which may cause acute graft loss or shorten allograft survival [2e4].In modern solid organ transplantation, human leukocyte antigen (HLA) laboratories regularly perform crossmatches between donor cells and recipient serum before transplantation. The close association between complementdependent cytotoxicity crossmatch (CDC-XM)-positivity and early graft loss has been reviewed [5], and since the

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Section: Discussionmentioning

confidence: 72%

Preformed C1q-binding Donor-specific Anti-HLA Antibodies and Graft Function After Kidney Transplantation

Okabe

Noguchi

Miyamoto

et al. 2018

Transplantation Proceedings

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“…A blood product is composed of three distinct parts (1): the desired product, such as red blood cells (RBCs) or platelets (2); excipients (e.g. anticoagulant or residual plasma) (3); residual leukocytes that carry HLA antigens, and in rare cases unexpected residual cells, such as platelets in red blood cells products (15). Leukocytes carry most of the antigenic load in a blood unit, yet the systematic use of leukoreduction process implemented in the late 90's to fight against Creutzfeldt-Jakob disease transmission dramatically reduced the amount of WBC into blood units (16,17).…”

Section: Discussionmentioning

confidence: 99%

Post-Transplantation Early Blood Transfusion and Kidney Allograft Outcomes: A Single-Center Observational Study

Khedjat¹,

Lenain

Hamroun³

et al. 2022

Transpl Int

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The association between blood transfusion and the occurrence of de novo HLA donor specific antibodies (DSA) after kidney transplantation remains controversial. In this single-center observational study, we examined the association between early blood transfusion, i.e. before 1-month post-transplantation, and the risk of DSA occurrence, using Luminex based-methods. In total, 1,424 patients with a minimum of 1-month follow-up were evaluated between January 2007 and December 2018. During a median time of follow-up of 4.52 years, we observed 258 recipients who had at least one blood transfusion during the first month post-transplantation. At baseline, recipients in the transfused group were significant older, more sensitized against HLA class I and class II antibodies and had a higher 1-month serum creatinine. Cox proportional hazards regression analyses did not show any significant association between blood transfusion and the risk of de novo DSA occurrence (1.35 [0.86–2.11], p = 0.19), the risk of rejection (HR = 1.33 [0.94–1.89], p = 0.11), or the risk of graft loss (HR = 1.04 [0.73–1.50], p = 0.82). These data suggest then that blood transfusion may not be limited when required in the early phase of transplantation, and may not impact long-term outcomes.

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“…Enfin, on a enfin remarqué -et ce, de façon très sensible -l'amélioration des conditions de confort des transfusions, avec moins de réactions fébriles non hémoly-tiques (RFNH) et de manifestations de type allergique, et donc inflammatoires. La leucoréduction astringente réduit les cas d'allo-immunisation, non pas seulement contre les Ag strictement (HNA) ou préférentiellement (HLA) leucocytaires, mais aussi contre les allo-Ag érythrocytaires et plaquettaires (HPA) [31][32][33].…”

Section: Les Leucocytesunclassified