ABO-incompatible Kidney Transplantation (abo-incompatible + kidney_transplantation)

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Medical Sciences100%

Selected Abstracts

Changes of Circulating Antibody Levels Induced by ABO Antibody Adsorption for ABO-Incompatible Kidney Transplantation

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2009
P. V. Valli
ABO-incompatible kidney transplantation using immunoadsorption to remove anti-A/B antibodies has become a successful clinical practice. Since the data on the specificity of the ABO columns are controversial, the present study assessed the efficiency and specificity of the ABO immunoadsorption, the effect on total immunoglobulins and antibodies previously induced by vaccination. Anti-A/B antibodies were measured by agglutination and ABO flow cytometry, total IgG/IgM, carbohydrate- and protein-specific antibodies by nephelometry and ELISA. The first immunoadsorption not only efficiently reduced donor-specific anti-A/B IgM (81%) and IgG (56%) but also reduced compatible anti-A/B IgM (59%) and IgG (34%). The measurements of antidonor A/B antibodies by direct agglutination (IgM) or flow cytometry better represented the effective antibody levels than the indirect agglutination test (IgG). The median reduction of total IgM and total IgG levels after a single immunoadsorption was 34% and 18%, respectively. Antibodies against pneumococcus and haemophilus polysaccharide antigens were significantly reduced, whereas antitetanus and antidiphtheria protein antibodies were not affected. Intravenous immunoglobulin administration restored the protective anticarbohydrate antibody levels. In summary, immunoadsorption efficiently removed antidonor A/B antibodies, but was not specific for A/B antigens. Anti-A/B antibody levels as determined by ABO flow cytometry are useful to establish the minimal number of immunoadsorptions needed for successful ABO-incompatible transplantation. [source]

Acute Antibody-Mediated Rejection in Living ABO-Incompatible Kidney Transplantation: Long-Term Impact and Risk Factors

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2009
D. Toki
The impact of acute antibody-mediated rejection (AAMR) on the long-term outcome on ABO-incompatible (ABOI) kidney transplantation is not well understood. We retrospectively analyzed the long-term impact of AAMR and risk factors for AAMR in 57 consecutive recipients performed between 1999 and 2004. Nineteen patients (33%) who developed AAMR within 3 months posttransplantation constituted of the AMR group. The graft survival rate was significantly lower in the AMR group (AMR vs. non-AMR, respectively; 5 years: 84% vs. 95%; 8 years: 45% vs. 95%; p = 0.009). The prevalence of transplant glomerulopathy at 1 year posttransplantation was significantly higher in the AMR group (AMR 64% vs. non-AMR 3%, p < 0.001). Multivariate analysis demonstrated that anti-blood group IgG antibody titers of 1:32 at the time of transplantation (OR, 9.52; p = 0.041) and donor-specific anti-HLA antibodies (DSHA) detected by Luminex single bead method (OR, 5.68; p = 0.015) were independent risk factors for AAMR regardless of baseline anti-blood group IgG antibody titers. Our results indicate that AAMR has a heavy impact on the long-term outcome and preoperative DSHA appears to have a more significant association with poor graft outcomes than anti-blood group antibodies, even in ABOI kidney transplantation. [source]

Changes of Circulating Antibody Levels Induced by ABO Antibody Adsorption for ABO-Incompatible Kidney Transplantation

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2009
P. V. Valli
ABO-incompatible kidney transplantation using immunoadsorption to remove anti-A/B antibodies has become a successful clinical practice. Since the data on the specificity of the ABO columns are controversial, the present study assessed the efficiency and specificity of the ABO immunoadsorption, the effect on total immunoglobulins and antibodies previously induced by vaccination. Anti-A/B antibodies were measured by agglutination and ABO flow cytometry, total IgG/IgM, carbohydrate- and protein-specific antibodies by nephelometry and ELISA. The first immunoadsorption not only efficiently reduced donor-specific anti-A/B IgM (81%) and IgG (56%) but also reduced compatible anti-A/B IgM (59%) and IgG (34%). The measurements of antidonor A/B antibodies by direct agglutination (IgM) or flow cytometry better represented the effective antibody levels than the indirect agglutination test (IgG). The median reduction of total IgM and total IgG levels after a single immunoadsorption was 34% and 18%, respectively. Antibodies against pneumococcus and haemophilus polysaccharide antigens were significantly reduced, whereas antitetanus and antidiphtheria protein antibodies were not affected. Intravenous immunoglobulin administration restored the protective anticarbohydrate antibody levels. In summary, immunoadsorption efficiently removed antidonor A/B antibodies, but was not specific for A/B antigens. Anti-A/B antibody levels as determined by ABO flow cytometry are useful to establish the minimal number of immunoadsorptions needed for successful ABO-incompatible transplantation. [source]

C4d deposition on peritubular capillary (PTC) in the protocol biopsy of ABO-incompatible kidney transplantation under the treatment with anti-CD20 antibody and without splenectomy

CLINICAL TRANSPLANTATION, Issue 2007
Naofumi Imai
Abstract:, For the desensitization of A/B antigens, we had developed and reported a new potent immunosuppressive treatment, which is the pre-prescription of anti-CD20 monoclonal antibody with mycophenolate mofetil and low-dose steroid. Using this kind of desensitization therapy, splenectomy is not required at the kidney transplantation. Complement C4d deposition on peritubular capillary (PTC) in graft biopsy has been reported as a relatively reliable marker for humoral rejection. However, the C4d deposition was often observed in the graft biopsy of ABO-incompatible kidney transplantation even with no rejection findings. The aim of this study was to examine the effect of this treatment on C4d deposition on PTC. Baseline and protocol graft biopsies obtained from 12 recipients of ABO incompatible kidney transplants were evaluated by light and immunofluorescence microscopy. To elucidate the involvement of classical and/or lectin pathway of complement cascades in C4d deposition, we examined the deposition of the initial activating proteins on PTC, IgG and IgM in the classical pathway and mannose-binding lectin (MBL), H-ficolin, L-ficolin, MBL-associated serine protease (MASP)-1 and MASP-2 in the lectin pathway. Three out of nine available baseline biopsy specimens showed diffuse C4d and IgM deposition on PTC. In the protocol biopsy, nine of 12 specimens revealed diffuse C4d deposition on PTC. Five of them had positive deposition of IgM and H-ficolin on PTC, whereas the other initial proteins were not detected in all specimens. Apart from one case, the histological findings of the protocol biopsies were normal or borderline changes. Our study suggested that although the new treatment with anti-CD20 antibody treatment and without splenectomy was clinically effective, it did not perfectly inhibit C4d deposition on PTC. It also confirmed the dual activation of both classical and lectin pathways in the process of C4d deposition on PTC in ABO-incompatible transplantation. [source]