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Titolo:
Impact of donor-specific antibodies on chronic rejection occurrence and graft loss in renal transplantation: Posttransplant analysis using flow cytometric techniques
Autore:
Piazza, A; Poggi, E; Borrelli, L; Servetti, S; Monaco, PI; Buonomo, O; Valeri, M; Torlone, N; Adorno, D; Casciani, CU;
Indirizzi:
CNR, Inst Tissue Typing, Unit Rome, Rome, Italy CNR Rome ItalyCNR, Inst Tissue Typing, Unit Rome, Rome, Italy Univ Roma Tor Vergata, Rome, Italy Univ Roma Tor Vergata Rome ItalyUniv Roma Tor Vergata, Rome, Italy
Titolo Testata:
TRANSPLANTATION
fascicolo: 8, volume: 71, anno: 2001,
pagine: 1106 - 1112
SICI:
0041-1337(20010427)71:8<1106:IODAOC>2.0.ZU;2-E
Fonte:
ISI
Lingua:
ENG
Soggetto:
SOLUBLE HLA ANTIGENS; ALLOGRAFT-REJECTION; CROSS-MATCH; MYCOPHENOLATE MOFETIL; KIDNEY-TRANSPLANT; CLASS-I; RECIPIENTS; RS-61443; SURVIVAL; INVITRO;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Life Sciences
Citazioni:
31
Recensione:
Indirizzi per estratti:
Indirizzo: Adorno, D CNR, Ist Tipizzazione Tissutale & Problemi Dialisi, Sezione Roma, Osp S Eugenio, Piazzale Umanesimo 10, I-00144 Rome, Italy CNR Piazzale Umanesimo 10 Rome Italy I-00144 -00144 Rome, Italy
Citazione:
A. Piazza et al., "Impact of donor-specific antibodies on chronic rejection occurrence and graft loss in renal transplantation: Posttransplant analysis using flow cytometric techniques", TRANSPLANT, 71(8), 2001, pp. 1106-1112

Abstract

Background. Improvements in immunosuppressive therapy have greatly reducedacute rejection (ARj) episodes, ensuring better short-term graft outcome, but have not modified long-term survival in renal transplantation. It is now well accepted that chronic rejection (CRj) can be determined by both immune and/or nonimmune mechanisms. The aim of this study was to evaluate the importance of the posttransplant humoral immune response towards mismatched HLA graft antigens in CRj occurrence and graft outcome. Methods. Serum samples from 120 nonpresensitized renal transplant recipients were prospectively screened for 1 year after surgery by means of flow cytometry cross-match (FCXM) and FlowPRA beads (microbeads coated with purified HLA class I and class II antigens) assays. All transplants were followed-up for 2 years or until graft removal. Results. FCXM monitoring identified donor-specific antibodies (DS-Abs) in 29 (24.2%) of 120 transplanted patients. Correlation with clinical data highlighted a higher incidence of ARj in DS-Abs-positive patients compared to negative patients (62% vs. 13%, P<0.00001). Furthermore, graft failure occurred more frequently among FCXM-positive patients than among negative patients (34% vs. 1%, P<0.00001). The deleterious effect of DS-Abs on graft function was confirmed by serum creatinine levels 2 years after transplantation. These were in fact higher in subjects producing DS-Abs than in subjects with only ARj (mean creatinine: 2.5 +/-1.3 mg/dL vs.1.7 +/-0.5 mg/dL, P=0.04). FlowPRA analysis of DS-Ab HLA specificity highlighted the presence of anti-HLA class I antibodies in 85% of FCXM-positive patients, who also presented with a higher incidence of HLA-B mismatches than FCXM-negative patients(1.23 +/-0.66 vs. 0.92 +/-0.59, P=0.02). Conclusions. Flow cytometric techniques are precious tools for investigating the activation of the humoral response against HLA antigens of the graftin renal transplantation. DS-Abs production has a worse impact on organ function and survival than ARj episodes. These findings represent further proof of the threat posed by DS-Abs on long-term graft function and draw attention to the need for a specific immunosuppressive therapy aimed at counteracting the different kinds of immune activation toward graft.

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Documento generato il 03/04/20 alle ore 11:03:01