scholarly journals De Novo Donor-specific HLA Antibodies Reduce Graft Survival and Increase Risk of Kidney Transplant Rejection: A Single-Center Retrospective Study

2020 ◽  
Author(s):  
Wei Liu ◽  
Jie Zhao ◽  
Zhong-Yu Kang ◽  
Yan-Li Xiao ◽  
Li Yang ◽  
...  
Keyword(s):  
Graft Survival ◽  
De Novo ◽  
Transplant Rejection ◽  
Survival Rates ◽  
Human Leukocyte ◽  
Leukocyte Antigen ◽  
Complement Dependent Cytotoxicity ◽  
Increase Risk ◽  
The Impact

Abstract Background: This study investigated the impact of posttransplantation de novo donor-specific anti-human leukocyte antigen antibodies (dnDSAs) on long-term death-censored graft survival and renal allograft rejection.Methods: This retrospective cohort study included 121 patients who received kidney transplants from deceased donors with negative complement-dependent cytotoxicity crossmatch. Based on the presence of dnDSAs, recipients were divided into dnDSA+ (n=31) and dnDSA− (n=90) groups. We evaluated the occurrence of rejection and long-term graft survival in the recipients along with pathologic changes in transplanted kidneys.Results: DnDSAs were identified in 31/121 (25.6%) patients, who had lower graft survival rates than patients without dnDSAs (P=0.007). There was no difference in graft survival rate between patients with high (≥4000) and low (<4000) DSA mean fluorescence intensity (P=0.669). The presence of dnDSA in serum was associated with a higher incidence of antigen- and T-cell–mediated rejection (P<0.0001). DnDSA+ and dnDSA− groups differed in terms of Banff score for arterial fibrointimal and arteriolar hyaline thickening (P<0.05).Conclusion: DnDSAs are associated with decreased long-term graft survival and increased rate of rejection, which is often accompanied by microcirculatory inflammation and positive C4d staining.

scholarly journals Influence of a low-dose tacrolimus protocol on the appearance of de novo donor-specific antibodies during 7-years of follow-up after renal transplantation

2020 ◽  
Author(s):  
Kohei Unagami ◽  
Hideki Ishida ◽  
Miyuki Furusawa ◽  
Kumiko Kitajima ◽  
Toshihito Hirai ◽  
...  
Keyword(s):  
De Novo ◽  
Trough Level ◽  
Human Leukocyte ◽  
Leukocyte Antigen ◽  
Serum Trough ◽  
Donor Specific Antibodies ◽  
Allograft Outcome ◽  
The Relationship

Abstract Background Tacrolimus (TAC) is a key immunosuppressant drug for kidney transplantation (KTx). However, the optimal serum trough level of TAC for good long-term outcomes remains unclear. This study aimed to investigate the relationship between the maintenance TAC trough level and the appearance of de novo donor-specific anti-human leukocyte antigen (HLA) antibodies (dnDSAs). Methods A total of 584 KTx recipients were enrolled in this study, of whom 164 developed dnDSAs during the follow-up period and 420 did not. Results We found no significant relationship between TAC trough level during the follow-up period and dnDSA incidence. Patients who developed dnDSAs had a significantly greater number of HLA-A/B/DR mismatches (3.4 ± 1.3 versus 2.8 ± 1.5; P &lt; 0.001), were more likely to have preformed DSAs (48.2% versus 27.1%; P &lt; 0.001) and showed poor allograft outcome. Conclusions There was no clear relationship between TAC trough level and dnDSA incidence for KTx recipients whose TAC trough levels were kept within the narrow range of 4–6 ng/mL during the immunosuppression maintenance period.

Effect of initial immunosuppression on long-term kidney transplant outcome in immunological low-risk patients

2018 ◽  
Vol 34 (8) ◽  
pp. 1417-1422 ◽  
Author(s):  
Laura A Michielsen ◽  
Arjan D van Zuilen ◽  
Marianne C Verhaar ◽  
Bram W Wisse ◽  
Elena G Kamburova ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Survival ◽  
Human Leukocyte ◽  
Low Risk ◽  
Kidney Graft ◽  
Free Survival ◽  
Leukocyte Antigen ◽  
Single Antigen ◽  
Risk Patients

Abstract Background Few studies have evaluated the effect of different immunosuppressive strategies on long-term kidney transplant outcomes. Moreover, as they were usually based on historical data, it was not possible to account for the presence of pretransplant donor-specific human-leukocyte antigen antibodies (DSA), a currently recognized risk marker for impaired graft survival. The aim of this study was to evaluate to what extent frequently used initial immunosuppressive therapies increase graft survival in immunological low-risk patients. Methods We performed an analysis on the PROCARE cohort, a Dutch multicentre study including all transplantations performed in the Netherlands between 1995 and 2005 with available pretransplant serum (n = 4724). All sera were assessed for the presence of DSA by a luminex single-antigen bead assay. Patients with a previous kidney transplantation, pretransplant DSA or receiving induction therapy were excluded from the analysis. Results Three regimes were used in over 200 patients: cyclosporine (CsA)/prednisolone (Pred) (n = 542), CsA/mycophenolate mofetil (MMF)/Pred (n = 857) and tacrolimus (TAC)/MMF/Pred (n = 811). Covariate-adjusted analysis revealed no significant differences in 10-year death-censored graft survival between patients on TAC/MMF/Pred therapy (79%) compared with patients on CsA/MMF/Pred (82%, P = 0.88) or CsA/Pred (79%, P = 0.21). However, 1-year rejection-free survival censored for death and failure unrelated to rejection was significantly higher for TAC/MMF/Pred (81%) when compared with CsA/MMF/Pred (67%, P < 0.0001) and CsA/Pred (64%, P < 0.0001). Conclusion These results suggest that in immunological low-risk patients excellent long-term kidney graft survival can be achieved irrespective of the type of initial immunosuppressive therapy (CsA or TAC; with or without MMF), despite differences in 1-year rejection-free survival.

The Impact of De Novo Donor-specific Anti-Human Leukocyte Antigen Antibodies on 5-Year Renal Transplant Outcome

2013 ◽  
Vol 45 (4) ◽  
pp. 1449-1452 ◽  
Author(s):  
M. Banasik ◽  
M. Boratyńska ◽  
K. Kościelska-Kasprzak ◽  
O. Mazanowska ◽  
M. Krajewska ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Human Leukocyte Antigen ◽  
De Novo ◽  
Human Leukocyte ◽  
Transplant Outcome ◽  
Leukocyte Antigen ◽  
The Impact

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 Correlation of Body Mass Index with Oncologic Outcomes in Colorectal Cancer Patients: A Large Population-Based Study

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3592
Author(s):  
Chong-Chi Chiu ◽  
Chung-Han Ho ◽  
Chao-Ming Hung ◽  
Chien-Ming Chao ◽  
Chih-Cheng Lai ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Body Mass Index ◽  
Body Weight ◽  
Body Mass ◽  
Survival Rates ◽  
Normal Weight ◽  
P Value ◽  
Administrative Claims ◽  
The Impact

It has been acknowledged that excess body weight increases the risk of colorectal cancer (CRC); however, there is little evidence on the impact of body mass index (BMI) on CRC patients’ long-term oncologic results in Asian populations. We studied the influence of BMI on overall survival (OS), disease-free survival (DFS), and CRC-specific survival rates in CRC patients from the administrative claims datasets of Taiwan using the Kaplan–Meier survival curves and the log-rank test to estimate the statistical differences among BMI groups. Underweight patients (<18.50 kg/m2) presented higher mortality (56.40%) and recurrence (5.34%) rates. Besides this, they had worse OS (aHR:1.61; 95% CI: 1.53–1.70; p-value: < 0.0001) and CRC-specific survival (aHR:1.52; 95% CI: 1.43–1.62; p-value: < 0.0001) rates compared with those of normal weight patients (18.50–24.99 kg/m2). On the contrary, CRC patients belonging to the overweight (25.00–29.99 kg/m2), class I obesity (30.00–34.99 kg/m2), and class II obesity (≥35.00 kg/m2) categories had better OS, DFS, and CRC-specific survival rates in the analysis than the patients in the normal weight category. Overweight patients consistently had the lowest mortality rate after a CRC diagnosis. The associations with being underweight may reflect a reverse causation. CRC patients should maintain a long-term healthy body weight.

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