Specific and durable elimination of antibody to donor HLA antigens in renal-transplant patients

Zachary, Andrea A.; Montgomery, Robert A.; Ratner, Lloyd E.; Samaniego-Picota, Millie; Haas, Mark; Kopchaliiska, Dessislava; Leffell, Mary S.

doi:10.1097/01.tp.0000090868.88895.e0

Cited by 171 publications

(134 citation statements)

References 23 publications

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“…Montgomery et al (25) followed up DSA of 49 kidney transplant recipients who underwent a desensitization protocol of PP/low-dosage IVIG and demonstrated that 63% lost DSA at the end of the treatment and 89% Ն2 mo after the end of treatment; however, the Mayo Clinic group showed that the majority of their desensitized patients continued to have low levels of DSA (26). In our study, 52% of patients lost DSA completely, and 30% lost some of their DSA or decreased DSA strength, indicating that both methods, high-dosage IVIG alone and PP/high-dosage IVIG, are effective in downregulating antibody production.…”

Section: Discussionmentioning

confidence: 99%

Addition of Plasmapheresis Decreases the Incidence of Acute Antibody-Mediated Rejection in Sensitized Patients with Strong Donor-Specific Antibodies

Akalin

Dinavahi

Friedlander

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: The objective of this study was to investigate the effects of desensitization protocols using intravenous Ig with or without plasmapheresis in patients with donor-specific anti-HLA antibodies on prevention of antibody-mediated rejection and downregulation of donor-specific antibodies.Design, setting, participants, & measurements: Thirty-five complement-dependent cytotoxicity T cell cross-match-negative but complement-dependent cytotoxicity B cell and/or flow cytometry cross-match-positive kidney transplant recipients were treated with high-dosage intravenous Ig plus Thymoglobulin induction treatment. Donor-specific antibody strength was stratified as strong, medium, or weak by Luminex flow beads. Group 1 patients had weak/moderate and group 2 strong donor-specific antibodies Results: Whereas no group 1 patients had acute rejection, 66% of group 2 had acute rejection (44% antibody-mediated rejection, 22% cellular rejection). The protocol was then changed to the addition of peritransplantation plasmapheresis to patients with strong donor-specific antibodies (group 3). This change resulted in a dramatic decrease in the acute rejection rate to 7%. During a median 18 mo of follow-up, patient survival was 100, 100, and 93% and graft survival was 100, 78, and 86% in groups 1, 2, and 3, respectively. During follow-up, 17 (52%) patients lost donor-specific antibodies completely, and 10 (30%) lost some of donor-specific antibodies and/or decreased the strength of existing donor-specific antibodies.Conclusions: These results indicated that in patients with strong donor-specific antibodies, the addition of plasmapheresis to high-dosage intravenous Ig decreases the incidence of acute rejection. The majority of the patients, whether they received intravenous Ig alone or with plasmapheresis, lost their donor-specific antibodies during follow-up.

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Section: Discussionmentioning

confidence: 99%

Addition of Plasmapheresis Decreases the Incidence of Acute Antibody-Mediated Rejection in Sensitized Patients with Strong Donor-Specific Antibodies

Akalin

Dinavahi

Friedlander

et al. 2008

Clinical Journal of the American Society of Nephrology

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“…Protocols that are similar to those used for treating AMR after transplantation also have proved useful in eliminating antibodies to donor HLA and ABO blood group antigens that existed before transplantation in sensitized patients, thereby allowing for successful transplantation of kidneys across these previously unscalable immunologic barriers (31,(35)(36)(37)(38)(39)(40). In biopsies of initially HLA-incompatible renal allografts, including biopsies that were performed for graft dysfunction and protocol biopsies of stably functioning grafts, we have found a strong association between PTC C4d staining and neutrophil margination, similar to findings in cases with a negative pretransplantation cross-match.…”

Section: C4d In Abo-incompatible Allografts: Rejection or Accommodation?mentioning

confidence: 99%

Antibody-Mediated Rejection in Renal Allografts

Racusen¹,

Haas²

2006

Clinical Journal of the American Society of Nephrology

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The past 15 years have seen major advances in the understanding of the effects of anti-donor antibodies on renal allografts at various stages after transplantation. These advances have been due in large part to pathologic examination of both early and late renal allograft biopsies, including both routine histologic evaluation and immunohistology to detect complement split products. As pathologists have become increasingly adept at diagnosing antibody-mediated rejection (AMR) on allograft biopsies, substantial progress has been made in the treatment of AMR and in successful renal transplantation in recipients with pre-existing antibodies against donor blood group (ABO) and/or major histocompatibility (HLA) antigens. This article reviews the pathologic features of hyperacute, acute, and chronic AMR, including some newer findings impacting diagnosis and outcomes, and differences in the implications of similar pathologic findings in ABO-versus HLA-incompatible renal allografts.

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“…After then, it has been an established method to overcome such incompatibility in several centers around the world, and for these experienced centers, donor kidney exchange is a far more simple and easy method to overcome the incompatibility of DRP than other protocols, including plasmapheresis or immunoadsorption (15,16). Some centers are even using donor kidney exchange to find donors with lesser HLA mismatch (3,4).…”

Section: Discussionmentioning

confidence: 99%

Outcome of Multipair Donor Kidney Exchange by a Web-Based Algorithm

Kim¹,

Kim²,

Kim³

et al. 2007

Journal of the American Society of Nephrology

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Specific and durable elimination of antibody to donor HLA antigens in renal-transplant patients

Abstract: Plasmapheresis and low-dose CMV-Ig combined with traditional immunosuppression is effective in producing a specific and durable elimination of antibody to donor HLA.

Cited by 171 publications

References 23 publications

Addition of Plasmapheresis Decreases the Incidence of Acute Antibody-Mediated Rejection in Sensitized Patients with Strong Donor-Specific Antibodies

Addition of Plasmapheresis Decreases the Incidence of Acute Antibody-Mediated Rejection in Sensitized Patients with Strong Donor-Specific Antibodies

Antibody-Mediated Rejection in Renal Allografts

Outcome of Multipair Donor Kidney Exchange by a Web-Based Algorithm

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