scholarly journals Optimal Immunosuppression Strategy in the Sensitized Kidney Transplant Recipient

2021 ◽  
Vol 10 (16) ◽  
pp. 3656
Author(s):  
Danae Olaso ◽  
Miriam Manook ◽  
Dimitrios Moris ◽  
Stuart Knechtle ◽  
Jean Kwun
Keyword(s):  
Immune Response ◽  
Transplant Recipient ◽  
Kidney Transplant Recipient ◽  
Human Leukocyte ◽  
Immunosuppressive Regimen ◽  
Human Leukocyte Antigens ◽  
Donor Pool ◽  
Hla Antibodies ◽  
Antibody Mediated Rejection ◽  
Leukocyte Antigens

Patients with previous sensitization events against anti-human leukocyte antigens (HLA) often have circulating anti-HLA antibodies. Following organ transplantation, sensitized patients have higher rates of antibody-mediated rejection (AMR) compared to those who are non-sensitized. More stringent donor matching is required for these patients, which results in a reduced donor pool and increased time on the waitlist. Current approaches for sensitized patients focus on reducing preformed antibodies that preclude transplantation; however, this type of desensitization does not modulate the primed immune response in sensitized patients. Thus, an optimized maintenance immunosuppressive regimen is necessary for highly sensitized patients, which may be distinct from non-sensitized patients. In this review, we will discuss the currently available therapeutic options for induction, maintenance, and adjuvant immunosuppression for sensitized patients.

scholarly journals Chronic Active Antibody-Mediated Rejection with Linear IgG Deposition on Glomerular Capillaries in a Kidney Transplant Recipient

Nephron ◽  
2020 ◽  
pp. 1-5
Author(s):  
Kenichiro Miura ◽  
Yoko Shirai ◽  
Naoto Kaneko ◽  
Tomoo Yabuuchi ◽  
Kiyonobu Ishizuka ◽  
...  
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
Cell Injury ◽  
Kidney Transplant Recipient ◽  
Hla Antigens ◽  
Human Leukocyte ◽  
Renal Hypoplasia ◽  
Hla Antibodies ◽  
Antibody Mediated Rejection ◽  
Glomerular Capillaries

Glomerular IgG deposition is rarely observed in antibody-mediated rejection. Here, we report chronic active antibody-mediated rejection with linear IgG deposition on glomerular capillary walls in a pediatric kidney transplant recipient. A 6-year-old boy with bilateral renal hypoplasia underwent preemptive deceased-donor kidney transplantation. Five years after the transplantation, an allograft biopsy revealed chronic active antibody-mediated rejection with diffuse linear IgG deposition on glomerular capillaries. Anti-glomerular basement membrane antibody, donor-specific anti-human leukocyte antigen (HLA) antibodies, and anti-angiotensin II type 1 receptor antibody were negative. A multiplex antibody assay identified anti-major histocompatibility complex class I chain-related molecule A antibody. Additionally, a single-antigen bead assay identified autoantibodies to 12 non-HLA antigens, including vimentin and glutathione S-transferase theta-1. To investigate whether IgG autoantibodies in the patient’s serum bind to antigens on glomerular capillaries, we incubated the patient’s serum with 0-h biopsy specimens of tissue donated to the patient and a control subject, both obtained immediately after nephrectomy from respective donors. IgG signals were observed in neither patient nor control samples. Nevertheless, linear IgG deposition may be explained by the binding of autoantibodies to non-HLA antigens that are usually hidden and only exposed via severe endothelial cell injury. Further studies are needed to confirm the significance of non-HLA antibodies in glomerular IgG deposition.

scholarly journals Challenges of the modern antibody diagnostics in kidney transplantation

2014 ◽  
Vol 155 (46) ◽  
pp. 1820-1830 ◽  
Author(s):  
Dániel Wettstein ◽  
Dorottya Szentiványi
Keyword(s):  
Solid Phase ◽  
Human Leukocyte ◽  
Human Leukocyte Antigens ◽  
Antibody Testing ◽  
Antibody Mediated Rejection ◽  
Transplant Patients ◽  
Leukocyte Antigens ◽  
Solid Phase Immunoassay ◽  
Kidney Transplant Patients ◽  
Review Reports

Overcoming antibody mediated rejection is of increasing interest in the field of transplantation immunology. The recipient’s antibodies against the graft human leukocyte antigens are responsible for antibody mediated graft injury. Introduction of the solid phase immunoassay technology radically changed the monitoring practice of antibodies against human leukocyte antigens, and this has consequences both for pretransplant and posttransplant phases, though our knowledge about the clinical interpretation of the detected antibodies is limited. This integrating review reports recommendations and algorithms regarding the management of kidney transplant patients. The detection of complement activation combined with the solid phase techniques is a promising new approach in antibody testing. The C4d and especially the more sensitive C1q methods have the potential to answer pivotal questions about the clinical relevance of antibodies. Answering the questions that the applied new methods raised and reviewing the recommendations are needed to remain up to date with this dynamically developing field. Orv. Hetil., 2014, 155(46), 1820–1830.

scholarly journals Antibody-Mediated Rejection and Sponge Effect in a Redo Lung Transplant Recipient

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Ashwini Arjuna ◽  
Michael T. Olson ◽  
Sofya Tokman ◽  
Rajat Walia ◽  
Thalachallour Mohanakumar ◽  
...  
Keyword(s):  
Transplant Recipient ◽  
Lung Transplant ◽  
Human Leukocyte ◽  
Lung Transplant Recipient ◽  
Term Survival ◽  
Antibody Mediated Rejection ◽  
Leukocyte Antigens ◽  
Allograft Failure ◽  
Donor Specific Antibodies

Long-term survival after lung transplant remains severely limited by chronic lung allograft dysfunction. Antibody-mediated rejection of lung transplant allografts is usually caused by donor-specific antibodies (DSAs) directed toward donor human leukocyte antigens (HLAs). Typically, patients with antibody-mediated rejection have significantly higher circulating DSAs and increased mean fluorescence intensity than those without antibody-mediated rejection. However, some patients with antibody-mediated rejection have low mean fluorescence intensities, partly due to the “sponge effect” related to DSAs binding to HLA molecules within the lung. Herein, we report the case of an 18-year-old, female lung transplant recipient who required retransplantation and developed circulating DSAs directed toward the first allograft but detected in circulation only after retransplantation. The present case draws attention to a rare finding of sponge effect in a patient with antibody-mediated rejection leading to allograft failure.

Human leukocyte antigens influence the immune response to a pre-S/S hepatitis B vaccine

Vaccine ◽  
1999 ◽  
Vol 17 (4) ◽  
pp. 330-339 ◽  
Author(s):  
A.B McDermott ◽  
S.B.A Cohen ◽  
J.N Zuckerman ◽  
J.A Madrigal
Keyword(s):  
Immune Response ◽  
Hepatitis B ◽  
Human Leukocyte ◽  
Hepatitis B Vaccine ◽  
Human Leukocyte Antigens ◽  
Leukocyte Antigens

scholarly journals Evaluation of the Humoral Immune Response to Human Leukocyte Antigens in Brazilian Renal Transplant Candidates

PLoS ONE ◽  
2014 ◽  
Vol 9 (6) ◽  
pp. e100270 ◽  
Author(s):  
Patricia Keiko Saito ◽  
Roger Haruki Yamakawa ◽  
Erica Pereira Aparecida ◽  
Waldir Verissimo da Silva Júnior ◽  
Sueli Donizete Borelli
Keyword(s):  
Immune Response ◽  
Renal Transplant ◽  
Humoral Immune Response ◽  
Human Leukocyte ◽  
Human Leukocyte Antigens ◽  
Humoral Immune ◽  
Leukocyte Antigens ◽  
Transplant Candidates

scholarly journals The Role of Major Histocompatibility Complex in Organ Transplantation- Donor Specific Anti-Major Histocompatibility Complex Antibodies Analysis Goes to the Next Stage -

2019 ◽  
Vol 20 (18) ◽  
pp. 4544 ◽  
Author(s):  
Tsukasa Nakamura ◽  
Takayuki Shirouzu ◽  
Katsuya Nakata ◽  
Norio Yoshimura ◽  
Hidetaka Ushigome
Keyword(s):  
Major Histocompatibility Complex ◽  
Organ Transplantation ◽  
Current Knowledge ◽  
Human Leukocyte ◽  
Strongly Correlated ◽  
Human Beings ◽  
Major Histocompatibility ◽  
Antibody Mediated Rejection ◽  
Leukocyte Antigens ◽  
Histocompatibility Complex

Organ transplantation has progressed with the comprehension of the major histocompatibility complex (MHC). It is true that the outcome of organ transplantation largely relies on how well rejection is managed. It is no exaggeration to say that to be well acquainted with MHC is a shortcut to control rejection. In human beings, MHC is generally recognized as human leukocyte antigens (HLA). Under the current circumstances, the number of alleles is still increasing, but the function is not completely understood. Their roles in organ transplantation are of vital importance, because mismatches of HLA alleles possibly evoke both cellular and antibody-mediated rejection. Even though the control of cellular rejection has improved by recent advances of immunosuppressants, there is no doubt that antibody-mediated rejection (AMR), which is strongly correlated with donor-specific anti-HLA antibodies (DSA), brings a poor outcome. Thus, to diagnose and treat AMR correctly is a clear proposition. In this review, we would like to focus on the detection of intra-graft DSA as a recent trend. Overall, here we will review the current knowledge regarding MHC, especially with intra-graft DSA, and future perspectives: HLA epitope matching; eplet risk stratification; predicted indirectly recognizable HLA epitopes etc. in the context of organ transplantation.

Sign in / Sign up

Export Citation Format

Share Document