scholarly journals Posttransplant Allosensitization in Low Immunological Risk Kidney and Kidney-Pancreas Graft Recipients

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Jorge Malheiro ◽  
Sandra Tafulo ◽  
Leonídio Dias ◽  
La Salete Martins ◽  
Isabel Fonseca ◽  
...  
Keyword(s):  
Risk Factor ◽  
Graft Loss ◽  
Graft Function ◽  
Kidney Graft ◽  
Hla Antibodies ◽  
Luminex Assay ◽  
Screening Protocol ◽  
Antibody Positivity ◽  
Cox Analysis ◽  
Pancreas Graft

Introduction. Posttransplantation allosensitization prevalence and effect on kidney grafts outcomes remain unsettled.Methods. Between 2007 and 2012, 408 patients received a primary kidney graft (with 68 patients also receiving a pancreas graft) after a negative cytotoxic crossmatch. All patients had a pretransplant negative anti-HLA screening and 0% panel reactive antibodies. We analyzed retrospectively the results of anti-HLA antibodies screening by Luminex assay, performed between 6 and 24 months after transplant, and searched for the risk factors for antibody positivity and its impact on kidney graft outcomes.Results. Anti-HLA antibodies prevalence at 6 months was 17.4%. Previous steroid-insensitive acute rejection was the only risk factor for both anti-HLA classes detected antibodies. Antithymocyte globulin induction was also a risk factor for anti-HLA-I antibodies. Antibody positivity status was associated with reduced graft function at 12 months and graft survival at 5 years (91.5% versus 96.4%,P=0.03). In multivariable Cox analysis, delayed graft function (HR = 6.1,P<0.01), HLA mismatches>3 (HR = 10.2,P=0.03), and antibody positivity for anti-HLA class II (HR = 5.1,P=0.04) or class I/II (HR = 13.8,P<0.01) were independent predictors of graft loss.Conclusions. Allosensitization against HLA classII±Iafter transplant was associated with adverse kidney graft outcomes. A screening protocol seems advisable within the first year in low immunological risk patients.

scholarly journals Impact of Early Pancreatic Graft Loss on Outcome after Simultaneous Pancreas–Kidney Transplantation (SPKT)—A Landmark Analysis

2021 ◽  
Vol 10 (15) ◽  
pp. 3237
Author(s):  
Lukas Johannes Lehner ◽  
Robert Öllinger ◽  
Brigitta Globke ◽  
Marcel G. Naik ◽  
Klemens Budde ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Graft Loss ◽  
Type I ◽  
Kidney Graft ◽  
Landmark Analysis ◽  
Pancreas Kidney Transplantation ◽  
Simultaneous Pancreas Kidney ◽  
Simultaneous Pancreas Kidney Transplantation ◽  
Pancreas Graft

(1) Background: Simultaneous pancreas–kidney transplantation (SPKT) is a standard therapeutic option for patients with diabetes mellitus type I and kidney failure. Early pancreas allograft failure is a complication potentially associated with worse outcomes. (2) Methods: We performed a landmark analysis to assess the impact of early pancreas graft loss within 3 months on mortality and kidney graft survival over 10 years. This retrospective single-center study included 114 adult patients who underwent an SPKT between 2005 and 2018. (3) Results: Pancreas graft survival rate was 85.1% at 3 months. The main causes of early pancreas graft loss were thrombosis (6.1%), necrosis (2.6%), and pancreatitis (2.6%). Early pancreas graft loss was not associated with reduced patient survival (p = 0.168) or major adverse cerebral or cardiovascular events over 10 years (p = 0.741) compared to patients with functioning pancreas, after 3 months. Moreover, kidney graft function (p = 0.494) and survival (p = 0.461) were not significantly influenced by early pancreas graft loss. (4) Conclusion: In this study, using the landmark analysis technique, early pancreas graft loss within 3 months did not significantly impact patient or kidney graft survival over 10 years.

scholarly journals Post-Transplant Natural Antibodies Associate with Kidney Allograft Injury and Reduced Long-Term Survival

2018 ◽  
Vol 29 (6) ◽  
pp. 1761-1770 ◽  
Author(s):  
Sarah B. See ◽  
Olivier Aubert ◽  
Alexandre Loupy ◽  
Yokarla Veras ◽  
Xavier Lebreton ◽  
...  
Keyword(s):  
Risk Factor ◽  
Confidence Interval ◽  
Graft Loss ◽  
Hazard Ratio ◽  
Natural Antibodies ◽  
Kidney Graft ◽  
Pathogenic Potential ◽  
Term Survival ◽  
Cox Regression Analysis ◽  
Post Transplant

Background The development of antibodies specific to HLA expressed on donor tissue (donor-specific antibodies [DSAs]) is a prominent risk factor for kidney graft loss. Non-HLA antibodies with pathogenic potential have also been described, including natural antibodies (Nabs). These IgG Nabs bind to immunogenic self-determinants, including oxidation-related antigens.Methods To examine the relationship of Nabs with graft outcomes, we assessed Nabs in blinded serum specimens collected from a retrospective cohort of 635 patients who received a transplant between 2005 and 2010 at Necker Hospital in Paris, France. Serum samples were obtained immediately before transplant and at the time of biopsy-proven rejection within the first year or 1 year after transplant. Nabs were detected by ELISA through reactivity to the generic oxidized epitope malondialdehyde.Results Univariate Cox regression analysis identified the development of post-transplant Nabs (defined as 50% increase in reactivity to malondialdehyde) as a significant risk factor for graft loss (hazard ratio, 2.68; 95% confidence interval, 1.49 to 4.82; P=0.001). Post-transplant Nabs also correlated with increased mean Banff scores for histologic signs of graft injury in post-transplant biopsy specimens. Multivariable Cox analyses confirmed Nabs development as a risk factor independent from anti-HLA DSAs (hazard ratio, 2.07; 95% confidence interval, 1.03 to 4.17; P=0.04). Moreover, patients with Nabs and DSAs had a further increased risk of kidney graft loss.Conclusions These findings reveal an association between Nabs, kidney graft injury, and eventual graft failure, suggesting the involvement of Nabs in immune mechanisms of rejection.

Hypercholesterolemia is a Risk Factor for Kidney Graft Loss from Chronic Rejection.

1999 ◽  
Vol 67 (7) ◽  
pp. S87
Author(s):  
K. Martin Wissing ◽  
Daniel Abramowicz ◽  
Pierre Vereerstraeten
Keyword(s):  
Risk Factor ◽  
Chronic Rejection ◽  
Graft Loss ◽  
Kidney Graft

Current Status of Kidney Graft in 6 Recipients after Pregnancy

1997 ◽  
Vol 10 (3) ◽  
pp. 213-215 ◽  
Author(s):  
V. Mazzarella ◽  
C. Tozzo ◽  
F. Pisani ◽  
G. Tisone ◽  
G. Splendiani ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Graft Loss ◽  
Graft Function ◽  
First Trimester ◽  
Current Status ◽  
Kidney Graft ◽  
Childbearing Age ◽  
Adverse Influence ◽  
University Of Rome

To determine whether pregnancy has an adverse influence on survival or graft function, a retrospective study was conducted. A total of 321 renal transplant(rTx) patients were followed on a day hospital basis of Tor Vergata University of Rome between January 1981 and April 1996. Out of 90 female subjects, 74 of childbearing age (less than 45 years) underwent the study. Six women had 7 pregnancies which resulted in 5 live births and two first trimester abortions. In one case the pregnancy occurred at 4 months after rTx: spontaneous abortion and acute rejection with graft loss occurred, for the four successful pregnancies the preconception serum creatinine (sCr) was 1.34 mg/dl (range: 1.3–1.4) and remained stable at the end of follow-up. The woman with two successful pregnancies had a sCr increase after second pregnancy, but it has remained stable at 4 yrs after rTx. The pt receiving rTx at 1981 with successful pregnancy after two yrs, reached ESRD 7 yrs after delivery because chronic rejection. Our data are consistent with other studies demonstrating no contraindication to pregnancy in women with stable renal transplant and controlled blood pressure. However, careful interdisciplinary monitoring is needed to reduce maternal and fetal risks.

scholarly journals The Value of Graft Implantation Sequence in Simultaneous Pancreas-Kidney Transplantation on the Outcome and Graft Survival

2021 ◽  
Vol 10 (8) ◽  
pp. 1632
Author(s):  
Hans-Michael Hau ◽  
Nora Jahn ◽  
Sebastian Rademacher ◽  
Elisabeth Sucher ◽  
Jonas Babel ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Graft Function ◽  
Kidney Graft ◽  
Significant Difference ◽  
Pancreas Kidney Transplantation ◽  
Simultaneous Pancreas Kidney ◽  
Graft Implantation ◽  
Simultaneous Pancreas Kidney Transplantation ◽  
Pancreas Graft

Background/Objectives: The sequence of graft implantation in simultaneous pancreas-kidney transplantation (SPKT) warrants additional study and more targeted focus, since little is known about the short- and long-term effects on the outcome and graft survival after transplantation. Material and methods: 103 patients receiving SPKT in our department between 1999 and 2015 were included in the study. Patients were divided according to the sequence of graft implantation into pancreas-first (PF, n = 61) and kidney-first (KF, n = 42) groups. Clinicopathological characteristics, outcome and survival were reviewed retrospectively. Results: Donor and recipient characteristics were similar. Rates of post-operative complications and graft dysfunction were significantly higher in the PF group compared with the KF group (episodes of acute rejection within the first year after SPKT: 11 (18%) versus 2 (4.8%); graft pancreatitis: 18 (18%) versus 2 (4.8%), p = 0.04; vascular thrombosis of the pancreas: 9 (14.8%) versus 1 (2.4%), p = 0.03; and delayed graft function of the kidney: 12 (19.6%) versus 2 (4.8%), p = 0.019). The three-month pancreas graft survival was significantly higher in the KF group (PF: 77% versus KF: 92.1%; p = 0.037). No significant difference was observed in pancreas graft survival five years after transplantation (PF: 71.6% versus KF: 84.8%; p = 0.104). Kidney graft survival was similar between the two groups. Multivariate analysis revealed order of graft implantation as an independent prognostic factor for graft survival three months after SPKT (HR 2.6, 1.3–17.1, p = 0.026) and five years (HR 3.7, 2.1–23.4, p = 0.040). Conclusion: Our data indicates that implantation of the pancreas prior to the kidney during SPKT has an influence especially on the early-post-operative outcome and survival rate of pancreas grafts.

scholarly journals Association of non-HLA antibodies against endothelial targets and donor-specific HLA antibodies with antibody-mediated rejection and graft function in pediatric kidney transplant recipients

2021 ◽  
Author(s):  
Alexander Fichtner ◽  
Caner Süsal ◽  
Britta Höcker ◽  
Susanne Rieger ◽  
Rüdiger Waldherr ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Hla Antibodies ◽  
Antibody Mediated Rejection ◽  
Peritubular Capillaries ◽  
Increased Risk ◽  
Antibody Positivity ◽  
Hla Antibody

Abstract Background Non-HLA antibodies against endothelial targets have been implicated in the pathogenesis of antibody-mediated rejection (ABMR), but data in pediatric patients are scarce. Methods We retrospectively analyzed a carefully phenotyped single-center (University Children’s Hospital Heidelberg, Germany) cohort of 62 pediatric kidney transplant recipients (mean age at transplantation, 8.6 ± 5.0 years) at increased risk of graft function deterioration. Patients had received their transplant between January 1, 1999, and January 31, 2010. We examined at time of late index biopsies (more than 1-year post-transplant, occurring after January 2004) the association of antibodies against the angiotensin II type 1 receptor (AT1R), the endothelin type A receptor (ETAR), the MHC class I chain-like gene A (MICA), and vimentin in conjunction with overall and complement-binding donor-specific HLA antibodies (HLA-DSA) with graft histology and function. Results We observed a high prevalence (62.9%) of non-HLA antibody positivity. Seventy-two percent of HLA-DSA positive patients showed additional positivity for at least one non-HLA antibody. Antibodies against AT1R, ETAR, and MICA were associated with the histological phenotype of ABMR. The cumulative load of HLA-DSA and non-HLA antibodies in circulation was related to the degree of microinflammation in peritubular capillaries. Non-HLA antibody positivity was an independent non-invasive risk factor for graft function deterioration (adjusted hazard ratio 6.38, 95% CI, 2.11–19.3). Conclusions Our data indicate that the combined detection of antibodies to HLA and non-HLA targets may allow a more comprehensive assessment of the patients’ immune responses against the kidney allograft and facilitates immunological risk stratification.

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