Relationship of Okt3 Sensitization and Vascular Rejection in Cardiac Transplant Patients Receiving Okt3 Rejection Prophylaxis

Hammond, Elizabeth H.; Wittwer, Carl T.; Greenwood, Jay H.; Knape, William A.; Yowell, Robert L.; Menlove, Ronald L.; Craven, Catherine; Renlund, Dale G.; Bristow, Michael R.; Dewitt, Charles W.

doi:10.1097/00007890-199011000-00008

Cited by 90 publications

(26 citation statements)

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“…Vascular rejection has also been associated with OKT3 induction and the consequent development of human antimouse antibodies [12]. However exposure to OKT3 is not necessary for the occurrence of vascular rejection.…”

Section: Discussionmentioning

confidence: 99%

Vascular rejection post heart transplantation is associated with positive flow cytometric cross-matching1

McCarthy

Cook

Massad

et al. 1998

European Journal of Cardio-Thoracic Surgery

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Objective: Use of flow cytometry cross-matching for measurement of donor-specific alloreactivity and monitoring anti-donor antibodies is well established. This study was performed to determine (1) its accuracy as a marker of vascular rejection, (2) its correlation with posttransplant outcome and (3) its ability to monitor highly sensitized patients requiring antibody removal with plasma exchange. Methods: Serial serum samples from 99 heart transplant recipients were examined for the presence of anti-donor antibodies of the IgG class that were reactive with T and/or B cryopreserved donor lymphocytes. A sub-group of 20 HLA sensitized patients required plasma exchange to remove the anti-HLA antibodies and were monitored with flow cytometry cross-matching to assess the degree of antibody removal. Results: Positive T-cell reactions were observed in 26 patients and positive B-cell reactions in 54. Twenty patients had vascular rejection. A significantly larger number of patients with a positive flow cytometry cross-match had vascular rejection (42% versus 12% for T-cell reactions, and 32% versus 7% for B-cell reactions; P = 0.002 each). Of the patients who had vascular rejection, 11 had a positive T-cell reaction (flow cytometry cross-match sensitivity of 55%), and 17 had a positive B-cell reaction (sensitivity of 85%). Of the 79 patients who did not develop vascular rejection, 64 had a negative T-cell reaction (specificity of 81%), and 42 had a negative B-cell reaction (specificity of 53%). The actuarial 2-year survival estimates were significantly higher in patients with negative T-cell reactions (90% versus 75%; P = 0.04), and B-cell reactions (95% versus 78%; P = 0.02). In the highly sensitized subgroup (n = 20) the effectiveness of plasma exchange to decrease anti-HLA antibody reactivity was a strong predictor of outcome. For patients in whom plasma exchange (PE) reduced anti-donor reactivity, 1-year survival was 87% compared to 25% in those whom PE did not reduce the level of antibody binding as assessed with flow cytometry cross-matching (P Ͻ 0.0001). Conclusions: Flow cytometry cross-matching provides a valuable marker for the detection of vascular rejection after cardiac transplantation. Quantitative measurements may allow evaluation of the efficacy of treatment modalities employed in the management of vascular rejection in an attempt to improve outcome.

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Section: Discussionmentioning

confidence: 99%

Vascular rejection post heart transplantation is associated with positive flow cytometric cross-matching1

McCarthy

Cook

Massad

et al. 1998

European Journal of Cardio-Thoracic Surgery

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“…1,8,79 Women have a disproportionately higher incidence of AMR, comprising up to 50% of the heart transplant recipients with AMR in reported series. 8,38 There is now clear evidence of a relationship between the presence of circulating anti-HLA antibody after transplantation and histological evidence of AMR.…”

Section: Risk Factorsmentioning

confidence: 97%

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

Colvin¹,

Cook²,

Chang³

et al. 2015

Circulation

287

251

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“…Younger age, congenital heart disease, positive donorspecific crossmatch, positive panel reactive antibody (PRA) titers, sensitization to OKT3, cytomegalovirus seropositivity and female gender have been identified as risk factors for AMR (1,2,5,8,11,(13)(14)(15).…”

Section: Clinical Featuresmentioning

confidence: 99%

Acute Antibody-Mediated Rejection Following Heart Transplantation

Uber¹,

Self²,

Bakel

et al. 2007

American Journal of Transplantation

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Acute antibody-mediated rejection (AMR) in heart transplantation is often associated with hemodynamic compromise, and is associated with increased mortality and development of accelerated transplant coronary artery disease (TCAD). The diagnosis of AMR has historically been controversial and outcomes with aggressive immunosuppressive therapy including plasmapheresis and cyclophosphamide are poor. Advances in diagnostic techniques like the demonstration of immunopathologic evidence for antibodymediated rejection by deposition of the complement split product C4d in tissue and detection of anti-HLA antibodies by flow cytometry will assist in further characterizing AMR. Immunosuppression targeting B-lymphocytes and use of m-TOR inhibitors to alter the predilection to develop TCAD and improve survival in AMR remains to be proven.

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Relationship of Okt3 Sensitization and Vascular Rejection in Cardiac Transplant Patients Receiving Okt3 Rejection Prophylaxis

Cited by 90 publications

References 0 publications

Vascular rejection post heart transplantation is associated with positive flow cytometric cross-matching1

Vascular rejection post heart transplantation is associated with positive flow cytometric cross-matching1

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

Acute Antibody-Mediated Rejection Following Heart Transplantation

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