Immunoadsorption With Protein A in Humoral Rejection of Kidney Transplants

Pretagostini, R.; Berloco, P.B.; Poli, L.; Cinti, P; Nicuolo, A. Di; Simone, P De; Colonnello, M; Salerno, Alfredo; Alfani, D; Cortesini, Raffaello

doi:10.1097/00002480-199609000-00067

Cited by 35 publications

(14 citation statements)

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“…It is also possible that lowaffinity antibodies that contribute to acute vascular rejection, whether or not they are specific for Gal␣1-3Gal, might be depleted by anti-Ig Therasorb columns even though they are not detected in in vitro assays. Regardless of the mechanisms that may eventually be found, clinical studies in HLA-presensitized patients have documented beneficial effects of posttransplant antibody depletion, including reversal of humorally-mediated rejection of renal allografts (49)(50)(51).…”

Section: Discussionmentioning

confidence: 99%

The role of antibodies in acute vascular rejection of pig-to-baboon cardiac transplants.

Lin

Weidner²,

Byrne³

et al. 1998

J. Clin. Invest.

259

161

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Long-term success in xenotransplantation is currently hampered by acute vascular rejection. The inciting cause of acute vascular rejection is not yet known; however, a variety of observations suggest that the humoral immune response of the recipient against the donor may be involved in the pathogenesis of this process. Using a pig-to-baboon heterotopic cardiac transplant model, we examined the role of antibodies in the development of acute vascular rejection. After transplantation into baboons, hearts from transgenic pigs expressing human decay-accelerating factor and CD59 underwent acute vascular rejection leading to graft failure within 5 d; the histology was characterized by endothelial injury and fibrin thrombi. Hearts from the transgenic pigs transplanted into baboons whose circulating antibodies were depleted using antiimmunoglobulin columns (Therasorb, Unterschleisshein, Germany) did not undergo acute vascular rejection in five of six cases. Biopsies from the xenotransplants in Ig-depleted baboons revealed little or no IgM or IgG, and no histologic evidence of acute vascular rejection in the five cases. Complement activity in the baboons was within the normal range during the period of xenograft survival. In one case, acute vascular rejection of a xenotransplant occurred in a baboon in which the level of antidonor antibody rose after Ig depletion was discontinued. This study provides evidence that antibodies play a significant role in the pathogenesis of acute vascular rejection, and suggests that acute vascular rejection might be prevented or treated by therapies aimed at the humoral immune response to porcine antigens. (

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Section: Discussionmentioning

confidence: 99%

The role of antibodies in acute vascular rejection of pig-to-baboon cardiac transplants.

Lin

Weidner²,

Byrne³

et al. 1998

J. Clin. Invest.

259

161

View full text Add to dashboard Cite

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“…90 reviewS exchange and immunoadsorption have been shown to rapidly lower circulating levels of Dsas. 90,91 in a small, randomized, controlled trial that compared the efficacy of immunoadsorption with the efficacy of conventional therapy in a series of 10 patients with acute amr, the high rate of allograft loss in the control group prompted early termination of the study. 92 the investigators con cluded that immunoadsorption was effective in revers ing severe, acute amr.…”

Section: Treatment Of Antibody-mediated Rejectionmentioning

confidence: 99%

Sensitized renal transplant recipients: current protocols and future directions

Gloor

Stegall

2010

Nat Rev Nephrol

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The identification of suitable donor kidneys for transplant candidates with high levels of circulating antibodies against human leukocyte antigen (HLA) is a major challenge and results in prolonged waiting times for transplantation. Technological advances in antibody characterization have permitted a more comprehensive assessment of anti-HLA antibody activity, as well as providing new insights into the clinical effect of HLA antibody class and specificity. Protocols have been developed that enable successful transplantation in patients with donor-specific antibodies (anti-HLA antibodies reactive against their donors). These protocols provide satisfactory early to intermediate-term allograft survival, and constitute an important advance in transplantation. Nevertheless, acute antibody-mediated rejection (AMR) remains a significant challenge, occurring in 20-50% of antibody-incompatible kidney transplantations. Although therapy directed toward lowering donor-specific antibody activity seems to be successful in reversing acute AMR, this condition still has an important negative impact on allograft survival. In addition, subclinical AMR seems to complicate a substantial proportion of positive-crossmatch transplantations even in the absence of allograft dysfunction, and may result in chronic histological abnormalities and shortened allograft function. New interventions for preventing acute AMR, such as anti-C5 antibody-mediated complement blockade and proteasome inhibitor-mediated plasma cell depletion, are promising therapeutic avenues currently under investigation.

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“…Some uncontrolled studies showed the promising results of immunoadsorption therapy with protein A with or without cyclophosphamide in the treatment of DSA‐positive rejection episodes resistant to conventional anti‐rejection therapy (151–155). Recently, Bohmig et al .…”

Section: The Antibody‐mediated Rejection Syndromes In Clinical Transpmentioning

confidence: 99%

The role of B cells and alloantibody in the host response to human organ allografts

Vongwiwatana

Tasanarong

Hidalgo

et al. 2003

Immunological Reviews

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Some human organ transplants deteriorate slowly over a period of years, often developing characteristic syndromes: transplant glomerulopathy (TG) in kidneys, bronchiolitis obliterans in lungs, and coronary artery disease in hearts. In the past, we attributed late graft deterioration to "chronic rejection", a distinct but mysterious immunologic process different from conventional rejection. However, it is likely that much of chronic rejection is explained by conventional T-cell-mediated rejection (TMR), antibody-mediated rejection (AMR), and other insults. Recently, criteria have emerged to now permit us to diagnose AMR in kidney transplants, particularly C4d deposition in peritubular capillaries and circulating antibody against donor human leukocyte antigens (HLA). Some cases with AMR develop TG, although the relationship of TG to AMR is complex. Thus, a specific diagnosis of AMR in kidney can now be made, based on graft damage, C4d deposition, and donor-specific alloantibodies. Criteria for AMR in other organs must be defined. Not all late rejections are AMR; some deteriorating organs probably have smoldering TMR. The diagnosis of late ongoing AMR raises the possibility of treatment to suppress the alloantibody, but efficacy of the available treatments requires further study.

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Immunoadsorption With Protein A in Humoral Rejection of Kidney Transplants

Cited by 35 publications

References 0 publications

The role of antibodies in acute vascular rejection of pig-to-baboon cardiac transplants.

The role of antibodies in acute vascular rejection of pig-to-baboon cardiac transplants.

Sensitized renal transplant recipients: current protocols and future directions

The role of B cells and alloantibody in the host response to human organ allografts

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