Association Between the Presence of Anti-HLA Antibodies With Acute Rejection and Chronic Allograft Nephropathy in the First Year After Kidney Transplantation

The impact of the kinetics of the anti-HLA antibodies after KTx on the occurrence of acute rejection as well as the better time-point to monitor anti-HLA Abs after transplantation is not completely defined. This prospective study followed 150 patients over 12 months after transplantation. Serum IgG anti-HLA Abs were detected by single antigen beads after typing donors and recipients for loci A, B, C, DR, and DQ. Before KTx, 89 patients did not present anti-HLA Abs and 2% developed “de novo” Abs during the 1st year, 39 patients were sensitized without DSAs, and 13% developed DSA after surgery; all of them presented ABMR. Sensitized patients presented higher acute rejection rates (36.4% versus 13.5%, p<0.001), although 60% of the patients did not present ABMR. Patients, in whom DSA-MFI decreased during the first two weeks after surgery, did not develop ABMR. Those who sustained their levels presented a rate of 22% of ABMR. 85% of patients developed ABMR when MFIs increased early after transplantation (which occurred in 30% of the DSA positive patients). In the ABMR group, we observed an iDSA-MFI sharp drop on the fourth day and then an increase between the 7th and 14th POD, which suggests DSA should be monitored at this moment in sensitized patients for better ABMR prediction.

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PRO – AND ANTI-INFLAMMATORY CYTOKINES ARE EARLY MARKERS OF ACUTE REJECTION OF THE TRANSPLANTED KIDNEY

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2018-25-3-119-124 ◽

2018 ◽

Vol 25 (3) ◽

pp. 119-124

Author(s):

T. V. FEDORENKO ◽

N. V. KOLESNIKOVA ◽

E. F. FILIPPOV

Keyword(s):

Renal Failure ◽

Kidney Transplantation ◽

Acute Rejection ◽

Inflammatory Cytokines ◽

Post Transplantation ◽

Diagnostic Significance ◽

Hla Antibodies ◽

Anti Inflammatory ◽

Xmap Technology

Aim. Determination of diagnostic significance of pro − and anti-inflammatory cytokines in early prognosis of posttransplant renal failure in patients with chronic renal disease.Materials and methods. In the peripheral blood of patients with chronic kidney disease 6 hours before kidney transplantation, multiplex analysis using Simplex ProcartaPlex panel (Bioscience, USA) and xMAP technology (principle of flow cytometry) was used to estimate the content of 10 cytokines: 7 proinflammatory (IL-1b, IL-6, IL-12p70, IL-27, IL-17A, IL-18) and 3 antiinflammatory (IL-1RA, IL-4, IL-13). Identification of HLA-antibodies was carried out with the help of multiplex immunological analysis, using test systems (Gen-Prob, USA), flow analyzer Luminex 200 xMAP technology (bimolecular reactions on the surface of microspheres).Results. The limited diagnostic significance of HLA-antibodies is due to the fact that their detection in the posttransplantation period can be either in the development of acute graft rejection, or in the favorable course of the period after the operation. Meanwhile, the determination of a number of blood cytokines before kidney transplantation allows predicting post-transplantation rejection. In particular, certain criteria favorable course of the period after kidney transplantation by absence of HLA antibodies in patients with chronic renal failure can be considered as the initial (within 6 hours of transplantation) low levels of IL1β, IL6, IL17а. Prognostically the increase in the blood levels of proinflammatory cytokines − IL6, IL17a and anti-inflammatory IL1-RA is a significant marker of acute rejection of a transplanted kidney. Along with this, it is important to note that the appearance of HLA antibodies in patients with a favorable course of the post-transplantation period is associated with an initially elevated level of proinflammatory cytokines such as Il1ß and IL6.Conclusion. Diagnostic value of the evaluated cytokines at the pre-transplant kidney patients determines the feasibility of the inclusion of evaluation of the serum concentration of IL1β, IL6, IL17a, IL1-RA in the programme of pre-transplant laboratory tests .

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Relationship of donor-specific class-I anti-HLA antibodies detected by ELISA after kidney transplantation on the development of acute rejection and graft survival

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfg068 ◽

2003 ◽

Vol 18 (5) ◽

pp. 990-995 ◽

Cited By ~ 26

Author(s):

G. Fernandez-Fresnedo ◽

J. M. Pastor ◽

M. Lopez-Hoyos ◽

J. C. Ruiz ◽

J. A. Zubimendi ◽

...

Keyword(s):

Kidney Transplantation ◽

Acute Rejection ◽

Graft Survival ◽

Class I ◽

Specific Class ◽

Hla Antibodies ◽

Relationship Of

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Flow Cytometry Panel-Reactive Antibody Screening of Anti-HLA Antibodies in the Waiting List Significantly Reduces the Occurrence of Acute Rejection After Kidney Transplantation

Transplantation Proceedings ◽

10.1016/j.transproceed.2017.04.016 ◽

2017 ◽

Vol 49 (8) ◽

pp. 1719-1723

Author(s):

I. Dedinská ◽

N. Mäčková ◽

K. Macháleková ◽

J. Miklušica ◽

B. Palkoci ◽

...

Keyword(s):

Flow Cytometry ◽

Kidney Transplantation ◽

Acute Rejection ◽

Waiting List ◽

Hla Antibodies ◽

Antibody Screening ◽

Panel Reactive Antibody ◽

Reactive Antibody

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The Kinetics of HLA Antibodies After Kidney Transplantation - the Impact On Acute Rejection and Graft Loss.

Transplantation Journal ◽

10.1097/00007890-201407151-01714 ◽

2014 ◽

Vol 98 ◽

pp. 512

Author(s):

E. Barbosa ◽

R. Souza ◽

F. Agena ◽

G. Maciel ◽

N. Panajotopoulos ◽

...

Keyword(s):

Kidney Transplantation ◽

Acute Rejection ◽

Graft Loss ◽

Hla Antibodies ◽

The Impact ◽

Kinetics Of

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Screening strategy for de novo donor‐specific HLA antibodies beyond the first year after kidney transplantation: Personalized or “one size fits all”?

Clinical Transplantation ◽

10.1111/ctr.14170 ◽

2020 ◽

Author(s):

Hasret Cun ◽

Gideon Hönger ◽

Marc Kleiser ◽

Patrizia Amico ◽

Caroline Wehmeier ◽

...

Keyword(s):

Kidney Transplantation ◽

De Novo ◽

Screening Strategy ◽

First Year ◽

Hla Antibodies

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1872: The Efficacy of Deoxyspergualin and Plasmapheresis for Antibody-Mediated Acute Rejection After Kidney Transplantation

The Journal of Urology ◽

10.1016/s0022-5347(18)39064-5 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 494-494

Author(s):

Michio Michio Nojima ◽

Tetsuro Yoshimoto ◽

Atsushi Nakao ◽

Takuo Maruyama ◽

Hidekazu Takiuchi ◽

...

Keyword(s):

Kidney Transplantation ◽

Acute Rejection

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Acute Rejection Following Kidney Transplantation: State-of-the-Art and Future Perspectives

Current Pharmaceutical Design ◽

10.2174/1381612826666200610184433 ◽

2020 ◽

Vol 26 (28) ◽

pp. 3468-3496

Author(s):

Emilio Rodrigo ◽

Marcio F. Chedid ◽

David San Segundo ◽

Juan C.R. San Millán ◽

Marcos López-Hoyos

Keyword(s):

Kidney Transplantation ◽

Acute Rejection ◽

Rescue Therapy ◽

Standard Of Care ◽

Rejection Rate ◽

New Drugs ◽

High Dose ◽

Current Standard ◽

Antibody Mediated Rejection ◽

Cellular Rejection

: Although acute renal graft rejection rate has declined in the last years, and because an adequate therapy can improve graft outcome, its therapy remains as one of the most significant challenges for pharmacists and physicians taking care of transplant patients. Due to the lack of evidence highlighted by the available metaanalyses, we performed a narrative review focused on the basic mechanisms and current and future therapies of acute rejection in kidney transplantation. : According to Kidney Disease/Improving Global Outcomes (KDIGO) guidelines, both clinical and subclinical acute rejection episodes should be treated. Usually, high dose steroids and basal immunosuppression optimization are the first line of therapy in treating acute cellular rejection. Rabbit antithymocytic polyclonal globulins are used as rescue therapy for recurrent or steroid-resistant cellular rejection episodes. Current standard-of-care (SOC) therapy for acute antibody-mediated rejection (AbMR) is the combination of plasma exchange with intravenous immunoglobulin (IVIG). Since a significant rate of AbMR does not respond to SOC, different studies have analyzed the role of new drugs such as Rituximab, Bortezomib, Eculizumab and C1 inhibitors. Lack of randomized controlled trials and heterogenicity among performed studies limit obtaining definite conclusions. Data about new direct and indirect B cell and plasma cell depleting agents, proximal and terminal complement blockers, IL-6/IL-6R pathway inhibitors and antibody removal agents, among other promising drugs, are reviewed.

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