scholarly journals Antibody-Mediated Rejection: Pathogenesis, Prevention, Treatment, and Outcomes

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Olivia R. Blume ◽  
Sarah E. Yost ◽  
Bruce Kaplan
Keyword(s):  
Plasma Cells ◽  
Graft Function ◽  
Human Leukocyte ◽  
Hla Typing ◽  
Antibody Detection ◽  
Peritubular Capillary ◽  
Leukocyte Antigen ◽  
Antibody Mediated Rejection ◽  
Transplant Failure

Antibody-mediated rejection (AMR) is a major cause of late kidney transplant failure. It is important to have an understanding of human-leukocyte antigen (HLA) typing including well-designed studies to determine anti-MHC-class-I-related chain A (MICA) and antibody rejection pathogenesis. This can allow for more specific diagnosis and treatment which may improve long-term graft function. HLA-specific antibody detection prior to transplantation allows one to help determine the risk for AMR while detection of DSA along with a biopsy confirms it. It is now appreciated that biopsy for AMR does not have to include diffuse C4d, but does require a closer look at peritubular capillary microvasculature. Although plasmapheresis (PP) is effective in removing alloantibodies (DSAs) from the circulation, rebound synthesis of alloantibodies can occur. Splenectomy is used in desensitization protocols for ABO incompatible transplants as well as being found to treat AMR refractory to conventional treatment. Also used are agents targeted for plasma cells, B cells, and the complement cascade which are bortezomib rituximab and eculizumab, respectively.

scholarly journals Chronic Antibody-Mediated Liver Rejection: More than Meets the Eye

2021 ◽  
Vol 2 (1) ◽  
pp. 1-7
Author(s):  
Claudia Rita ◽  
Ignacio Iturrieta-Zuazo ◽  
Rubén Ballester-González ◽  
Nieves Alonso-Alarcón ◽  
Esther Moreno-Moreno ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Chronic Rejection ◽  
Human Leukocyte ◽  
Hla Typing ◽  
Leukocyte Antigen ◽  
Antibody Mediated Rejection ◽  
Morphological Criteria ◽  
Single Antigen ◽  
The Moment

Understanding the role of donor-specific antibodies (DSAs) in liver transplantation remains an investigative priority. Acute and chronic rejection associated with DSAs have been described. However, most transplant protocols did not consider the presence of DSAs at the moment of liver transplantation (LTx) or for the follow-up. A 65-year-old man received an ABO-compatible LTx for cirrhosis. Ten years after the LTx, he presented with a progressive elevation of liver enzymes and bilirubin. The single antigen Luminex bead assay showed the presence of DSAs against several DQ2, DQ7, and DQ8 alleles. The patient received several desensitization treatments regarding the persistence of DSAs. The anatomopathological study confirms chronic rejection. Although in this case the immunohistochemical deposits of C4d were negative, the data revealed morphological criteria of chronic graft injury and DSAs’ incompatibilities explained by structural analysis. These data support an antibody-mediated rejection (AMR). It could be reasonable to establish a protocol for human leukocyte antigen (HLA) typing of every LTx donor and recipient as well as a periodic follow-up to assess the presence of DSAs. This will make it possible to carry out studies of donor–recipient incompatibility and to confirm the existence of probable cases of AMR.

Role of crossmatch testing when Luminex-SAB is negative in renal transplantation

2018 ◽  
Vol 90 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Kumar Jayant ◽  
Isabella Reccia ◽  
Bridson M Julie ◽  
Ajay Sharma ◽  
Ahmed Halawa
Keyword(s):  
Solid Phase ◽  
Human Leukocyte ◽  
Hla Typing ◽  
Antibody Detection ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Detection Techniques ◽  
Leukocyte Antigen ◽  
Hla Antibody

The human leukocyte antigen (HLA) system plays an important role in the acceptance of renal graft. Long and better graft survival has been reported in patients with HLA-identical siblings and a nonreactive cytotoxicity assay (CDC). New methods of HLA-typing and anti-HLA antibody detection techniques such as flow cytometry, solid-phase immunoassays, or antigen bead assays have further improved the outcomes of renal transplant recipients. In the present review, the explicit details of these methodologies are discussed in detail.

De Novo Donor-Specific Anti–Human Leukocyte Antigen Antibody Detection in Long-Term Adult Liver Transplantation

2016 ◽  
Vol 48 (9) ◽  
pp. 2980-2982 ◽  
Author(s):  
D. San Segundo ◽  
C. Alonso ◽  
P. Ruiz ◽  
I. Roman ◽  
M.T. Arias-Loste ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Human Leukocyte Antigen ◽  
De Novo ◽  
Human Leukocyte ◽  
Antibody Detection ◽  
Adult Liver ◽  
Leukocyte Antigen ◽  
Antigen Antibody

scholarly journals Human Leukocyte Antigen and Red Blood Cells Impact Umbilical Cord Blood CD34+ Cell Viability after Thawing

2019 ◽  
Vol 20 (19) ◽  
pp. 4875 ◽  
Author(s):  
Vanegas ◽  
Galindo ◽  
Páez-Gutiérrez ◽  
González-Acero ◽  
Medina-Valderrama ◽  
...  
Keyword(s):  
Human Leukocyte Antigen ◽  
Cell Viability ◽  
Cord Blood ◽  
Red Blood Cells ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Blood Cells ◽  
Human Leukocyte ◽  
Hla Typing ◽  
Leukocyte Antigen

Hematopoietic progenitor cell (HPC) transplantation is a treatment option for malignant and nonmalignant diseases. Umbilical cord blood (UCB) is an important HPC source, mainly for pediatric patients. It has been demonstrated that human leukocyte antigen (HLA) matching and cell dose are the most important features impacting clinical outcomes. However, UCB matching is performed using low resolution HLA typing and it has been demonstrated that the unnoticed mismatches negatively impact the transplant. Since we found differences in CD34+ viability after thawing of UCB units matched for two different patients (p = 0.05), we presumed a possible association between CD34+ cell viability and HLA. We performed a multivariate linear model (n = 67), comprising pre-cryopreservation variables and high resolution HLA genotypes separately. We found that pre-cryopreservation red blood cells (RBC), granulocytes, and viable CD34+ cell count significantly impacted CD34+ viability after thawing, along with HLA-B or -C (R2 = 0.95, p = 0.01; R2 = 0.56, p = 0.007, respectively). Although HLA-B*40:02 may have a negative impact on CD34+ cell viability, RBC depletion significantly improves it.

scholarly journals Transplantation for bone marrow failure: current issues

Hematology ◽  
2016 ◽  
Vol 2016 (1) ◽  
pp. 90-98 ◽  
Author(s):  
Régis Peffault de Latour
Keyword(s):  
Bone Marrow Failure ◽  
Clonal Evolution ◽  
Human Leukocyte ◽  
Unrelated Donor ◽  
Hematopoietic Stem ◽  
Leukocyte Antigen ◽  
Sibling Donor ◽  
Alternative Donor

Abstract The preferred treatment of idiopathic aplastic anemia (AA) is allogeneic hematopoietic stem cell transplantation (HSCT) from a human leukocyte antigen (HLA)–identical sibling donor. Transplantation from a well-matched unrelated donor (MUD) may be considered for patients without a sibling donor after failure of immunosuppressive therapy, as may alternative transplantation (mismatched, cord blood or haplo-identical HSCT) for patients without a MUD. HSCT may also be contemplated for congenital disorders in cases of pancytopenia or severe isolated cytopenia. Currently, HSCT aims are not only to cure patients but also to avoid long-term complications, notably chronic graft-versus-host disease (GVHD), essential for a good quality of life long term. This paper summarizes recent advances in HSCT for idiopathic and inherited AA disorders. The effect of age on current transplantation outcomes, the role of transplantation in paroxysmal nocturnal hemoglobinuria, and the prevention of GVHD are also discussed. Emerging strategies regarding the role of up-front unrelated donor and alternative donor HSCT in idiopathic AA, along with advances in the treatment of clonal evolution in Fanconi anemia, are also examined.

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.

scholarly journals Performance Characteristics of Updated INNO-LiPA Assays for Molecular Typing of Human Leukocyte Antigen A (HLA-A), HLA-B, and HLA-DQB1 Alleles

2004 ◽  
Vol 11 (2) ◽  
pp. 430-432 ◽  
Author(s):  
Karen De Vreese ◽  
Rachel Barylski ◽  
Fiona Pughe ◽  
Miriam Bläser ◽  
Colin Evans ◽  
...  
Keyword(s):  
Performance Evaluation ◽  
Human Leukocyte Antigen ◽  
Molecular Typing ◽  
Human Leukocyte ◽  
Performance Characteristics ◽  
Hla Typing ◽  
Tissue Typing ◽  
Leukocyte Antigen ◽  
Antigen A ◽  
Accuracy Rates

ABSTRACT We carried out a multicenter performance evaluation of three new DNA-based human leukocyte antigen (HLA) typing assays: INNO-LiPA HLA-A Update, INNO-LiPA HLA-B Update, and INNO-LiPA HLA-DQB1 Update. After optimization, the accuracy rates were all 100%, and the final observed resolutions were 99.4, 92.4, and 85.6%, respectively. These rapid and easy-to-perform assays yielded results fully concordant with other DNA-based tissue typing tests.

scholarly journals Mesenchymal Stromal Cell Therapy in Solid Organ Transplantation

2021 ◽  
Vol 11 ◽  
Author(s):  
Manuel Alfredo Podestà ◽  
Giuseppe Remuzzi ◽  
Federica Casiraghi
Keyword(s):  
Organ Transplantation ◽  
Patient Survival ◽  
Immunosuppressive Agents ◽  
Graft Function ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Clinical Models ◽  
Transplant Failure

Transplantation is the gold-standard treatment for the failure of several solid organs, including the kidneys, liver, heart, lung and small bowel. The use of tailored immunosuppressive agents has improved graft and patient survival remarkably in early post-transplant stages, but long-term outcomes are frequently unsatisfactory due to the development of chronic graft rejection, which ultimately leads to transplant failure. Moreover, prolonged immunosuppression entails severe side effects that severely impact patient survival and quality of life. The achievement of tolerance, i.e., stable graft function without the need for immunosuppression, is considered the Holy Grail of the field of solid organ transplantation. However, spontaneous tolerance in solid allograft recipients is a rare and unpredictable event. Several strategies that include peri-transplant administration of non-hematopoietic immunomodulatory cells can safely and effectively induce tolerance in pre-clinical models of solid organ transplantation. Mesenchymal stromal cells (MSC), non-hematopoietic cells that can be obtained from several adult and fetal tissues, are among the most promising candidates. In this review, we will focus on current pre-clinical evidence of the immunomodulatory effect of MSC in solid organ transplantation, and discuss the available evidence of their safety and efficacy in clinical trials.

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