P1797ACUTE RENAL GRAFT FAILURE ASSOCIATED WITH AT1 RECEPTOR ANTIBODIES : 2 CASES IN SKMC

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nihal Bashir ◽  
Mohamed AlSeiari
Keyword(s):  
Acute Rejection ◽  
Graft Function ◽  
Hyperacute Rejection ◽  
Hla Antibodies ◽  
Antibody Mediated Rejection ◽  
Donor Specific Antibodies ◽  
Stage Renal Disease ◽  
End Stage ◽  
Receptor Antibodies

Abstract Background and Aims Some kidney transplantation recipients with negative donor specific antibodies can develop acute rejection episodes which are difficult to treat, associated with non-HLA antibodies like angiotensin 2 type 1 receptor antibodies (AT1R Ab). The mechanism of rejection by AT1R ab involves vascular injury. Our cases are unique as the first patient got mineralocorticoid deficiency like picture unexpectedly. For the second case, hyperacute rejection cause in the first allograft was not identified and but hyperacute rejection episodes involving antibodies against endothelial cells are reported in literature. Method 2 patients received renal transplantation from life related donors in out institute developed acute rejection episodes. As part of investigations, we did non -HLA antibodies testing which came positive . Results Case 1 30 years old male, with end stage renal disease on hemodialysis . The patient had a live related renal transplant with Mismatch 1-1-1 and negative DSA. Induction with Basiliximab was initiated but changed to ATG due to delayed graft function. Kidney biopsy on day 6 post operatively showed diffuse moderate to severe acute tubular injury (up to necrosis) with glomerular intracapillary fibrin microthrombi, focal minimal peritubular capillaritis and mild glomerulitis and focal weak C4d positivity, highly suspicious for active antibody mediated rejection. The patient was treated with pulse steroids, ATG total of 7.5mg/kg, 3 sessions of Plasma exchange and IVIG 2 g/kg and 2 doses of Rituximab for his hyperacute rejection. AT1R antibodies titer was 11U/ml. MICA was negative. Losartan was initiated as a maintenance therapy.

scholarly journals Non-HLA Antibodies and Epitope Mismatches in Kidney Transplant Recipients With Histological Antibody-Mediated Rejection

2021 ◽  
Vol 12 ◽  
Author(s):  
Marta Crespo ◽  
Laura Llinàs-Mallol ◽  
Dolores Redondo-Pachón ◽  
Carrie Butler ◽  
Javier Gimeno ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
De Novo ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Serum Samples ◽  
Hla Antibodies ◽  
Aortic Endothelial Cells ◽  
Antibody Mediated Rejection ◽  
Donor Specific Antibodies

BackgroundCorrelation between antibody-mediated rejection (ABMR) and circulating HLA donor-specific antibodies (HLA-DSA) is strong but imperfect in kidney transplant (KT) recipients, raising the possibility of undetected HLA-DSA or non-HLA antibodies contributing to ABMR. Detailed evaluation of the degree of HLA matching together with the identification of non-HLA antibodies in KT may help to decipher the antibody involved.MethodsWe retrospectively assessed patients with transplant biopsies scored following Banff’15 classification. Pre- and post-transplant serum samples were checked for HLA and non-HLA antibodies [MICA-Ab, angiotensin-II type-1-receptor (AT1R)-Ab, endothelin-1 type-A-receptor (ETAR)-Ab and crossmatches with primary aortic endothelial cells (EC-XM)]. We also analyzed HLA epitope mismatches (HLA-EM) between donors and recipients to explore their role in ABMR histology (ABMRh) with and without HLA-DSA.ResultsOne-hundred eighteen patients with normal histology (n = 19), ABMRh (n = 52) or IFTA (n = 47) were studied. ABMRh patients were HLA-DSApos (n = 38, 73%) or HLA-DSAneg (n = 14, 27%). Pre-transplant HLA-DSA and AT1R-Ab were more frequent in ABMRh compared with IFTA and normal histology cases (p = 0.006 and 0.003), without differences in other non-HLA antibodies. Only three ABMRhDSAneg cases showed non-HLA antibodies. ABMRhDSAneg and ABMRhDSApos cases showed similar biopsy changes and graft-survival. Both total class II and DRB1 HLA-EM were associated with ABMRhDSApos but not with ABMRhDSAneg. Multivariate analysis showed that pre-transplant HLA-DSA (OR: 3.69 [1.31–10.37], p = 0.013) and AT1R-Ab (OR: 5.47 [1.78–16.76], p = 0.003) were independent predictors of ABMRhDSApos.ConclusionsIn conclusion, pre-transplant AT1R-Ab is frequently found in ABMRhDSApos patients. However, AT1R-Ab, MICA-Ab, ETAR-Ab or EC-XM+ are rarely found among ABMRhDSAneg patients. Pre-transplant AT1R-Ab may act synergistically with preformed or de novo HLA-DSA to produce ABMRhDSApos but not ABMRhDSAneg. HLA epitope mismatch associates with ABMRhDSApos compared with ABMRhDSAneg, suggesting factors other than HLA are responsible for the damage.

scholarly journals Laparoscopic Splenectomy to Salvage Renal Transplants from Severe Acute Antibody-Mediated Rejection

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Michael Latzko ◽  
Sakshi Jasra ◽  
Sana Akbar ◽  
Harry Sun ◽  
Sadanand Palekar
Keyword(s):  
Renal Function ◽  
Laparoscopic Splenectomy ◽  
Rescue Therapy ◽  
Graft Function ◽  
Renal Transplants ◽  
Antibody Mediated Rejection ◽  
Class 1 ◽  
Stage Renal Disease ◽  
End Stage ◽  
Living Related

Purpose. Acute antibody-mediated rejection, a complication of cross match positive and sensitized renal transplants, occurs despite the use of standard desensitization protocols. Rescue therapy consists of plasmapheresis and intravenous immunoglobulin (IVIg). In patients with preformed donor specific antibodies, rejection can be aggressive. We report here a case in which laparoscopic splenectomy was added to the standard rescue regimen.Case Report and Results. A 40-year-old Hispanic female with end stage renal disease had been receiving hemodialysis. The patient had numerous class 1 unacceptable antigens. She was scheduled to undergo an incompatible 1-1-1 mismatch living related donor kidney transplant. Preoperatively, the patient received plasmapheresis, IVIG, and thymoglobulin. There was good graft function until postoperative day 5. At that point, worsening renal function was noted. Renal biopsy was consistent with AMR. The patient became anuric and dialysis was initiated. To salvage the transplant, the patient underwent laparoscopic splenectomy. Postoperatively, renal function improved. Two years after transplant, the patient continues to have excellent graft function.Conclusion. In a small but significant number of renal transplants, antibody production occurs at a rate that traditional treatments are unable to reduce effectively. Based on our experience, the addition of splenectomy to standard rescue therapy can salvage renal transplants.

scholarly journals Low Incidence of End-Stage Renal Disease in Childhood-Onset Type 1 Diabetes Followed for Up to 42 Years

Diabetes Care ◽  
2017 ◽  
Vol 41 (3) ◽  
pp. 420-425 ◽  
Author(s):  
Vibeke Gagnum ◽  
Maryam Saeed ◽  
Lars C. Stene ◽  
Torbjørn Leivestad ◽  
Geir Joner ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Childhood Onset ◽  
Onset Type ◽  
Low Incidence ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Laparoscopic-Assisted Recipient Nephrectomy and Recipient Kidney Procurement during Orthotopic Living-Related Kidney Transplantation

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Dimitri Mikhalski ◽  
Karl Martin Wissing ◽  
Renaud Bollens ◽  
Daniel Abramowicz ◽  
Vincent Donckier ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Antiphospholipid Antibodies ◽  
Graft Function ◽  
Renal Vessels ◽  
Short Period ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage ◽  
Living Related ◽  
Laparoscopic Assisted

Advanced atherosclerosis or thrombosis of iliac vessels can constitute an absolute contraindication for heterotopic kidney transplantation. We report the case of a 42-year-old women with end-stage renal disease due to lupus nephritis and a history of bilateral thrombosis of iliac arteries caused by antiphospholipid antibodies. Occlusion had been treated by the bilateral placement of wall stents which precluded vascular anastomosis. The patient was transplanted with a right kidney procured by laparoscopic nephrectomy from her HLA semi-identical sister. The recipient had left nephrectomy after laparoscopical transperitoneal dissection. The donor kidney was orthotopically transplanted with end-to-end anastomosis of graft vessels to native renal vessels and of the graft and native ureter. Although, the patient received full anticoagulation because of a cardiac valve and antiphospholipid antibodies, she had no postoperative complication in spite of a short period of delayed graft function. Serum creatinine levels three months after transplantation were at 1.0 mg/dl. Our case documents that orthotopical transplantation of laparoscopically procured living donor kidneys at the site of recipient nephrectomy is a feasible procedure in patients with surgical contraindication of standard heterotopic kidney transplantation.

Plasmapheresis Therapy in Kidney Transplant Rejection

2018 ◽  
Vol 47 (1-3) ◽  
pp. 73-84 ◽  
Author(s):  
Pan Xie ◽  
Min Tao ◽  
Kanfu Peng ◽  
Hongwen Zhao ◽  
Keqin Zhang ◽  
...  
Keyword(s):  
End Stage Renal Disease ◽  
Multimodal Treatment ◽  
Transplant Rejection ◽  
Human Leukocyte ◽  
Economic Costs ◽  
Leukocyte Antigen ◽  
Antibody Mediated Rejection ◽  
Stage Renal Disease ◽  
End Stage ◽  
Optimal Treatment Strategy

Kidney transplantation (KT) is considered an optimal treatment strategy for end-stage renal disease. But human leukocyte antigen-sensitized, ABO-incompatible and antibody-mediated rejection might be the alarming hurdles in KT. Therapeutic plasma exchange is the mainstay of the antibody reduction therapy for reducing autoantibody more effectively. Even in the treatment for highly sensitized patients, it has played an indispensable role. However, clinicians should tailor therapies to individual patient’s needs and multimodal treatment will bring better outcomes. Early diagnosis and precise treatment would reduce morbidity, mortality, and economic costs.

Angiotensin II Type 1 Receptor Gene Polymorphism in End-Stage Renal Disease

Nephron ◽  
2002 ◽  
Vol 92 (1) ◽  
pp. 51-55 ◽  
Author(s):  
Monika Buraczynska ◽  
Piotr Ksiazek ◽  
Wojciech Zaluska ◽  
Danuta Spasiewicz ◽  
Teresa Nowicka ◽  
...  
Keyword(s):  
Angiotensin Ii ◽  
Gene Polymorphism ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Receptor Gene ◽  
Receptor Gene Polymorphism ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals IMMUNODIAGNOSIS IN MEMBRANOUS NEPHROPATHY

2020 ◽  
Vol 73 (9) ◽  
pp. 1861-1866
Author(s):  
Magdalena Ratajczak ◽  
Ewa Poleszak ◽  
Tomasz Chrościcki
Keyword(s):  
Membranous Nephropathy ◽  
Antinuclear Antibodies ◽  
Aim Analysis ◽  
Non Invasive ◽  
Phospholipase A2 Receptor ◽  
Secondary Form ◽  
Stage Renal Disease ◽  
End Stage ◽  
Receptor Antibodies ◽  
Primary Form

One of the diseases leading to chronic end-stage renal disease is membranous nephropathy (MN). The main cause of this disease is the formation of antibodies to foreign and native antigens. Membranous nephropathy can be conventionally divided into 2 types: primary form (when the primary disease is unknown) and secondary form. Detection of appropriate antibodies is one of the methods to recognize and differentiate primary and secondary forms. A large role in non-invasive diagnosis of MN and differentiation of the primary form from the secondary play antinuclear antibodies (ANA), antibodies against granulocyte cytoplasm (ANCA), antiglomerular basement antibodies (anti-GBM) and phospholipase A2 receptor antibodies (anti-PLA2R). Differentiation matters when choosing a treatment choice. In the primary form, it is immunosuppression, and in the form of secondary treatment, it consists in curing or controlling diseases that can cause symptoms of MN. The aim: Analysis of serological methods helpful in immunodiagnosis of membranous nephropathy.

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