Maxime Touzot1, Grégoire Couvrat-Desvergnes, Stéphanie Castagnet, Anne Cesbron, Karine Renaudin, Diego Cantarovich, Magali Giral. 1. 1 Institut National de la Sante Et de la Recherche Medicale INSERM U1064, Nantes, France. 2 Institut de Transplantation Urologie Néphrologie du Centre Hospitalier Universitaire Hôtel Dieu, Nantes, France. 3 Etablissement Français du Sang (EFS), Laboratoire HLA, Nantes, France. 4 Service D'anatomie Pathologique, Centre Hospitalier Universitaire Hôtel Dieu, Nantes, France. 5 Faculté De Médecine, Université de Nantes, Nantes, France. 6 CIC Biotherapy, Centre Hospitalier Universitaire Hôtel Dieu, Nantes, France.
Abstract
BACKGROUND: Donor-specific antibodies (DSA) are considered as reliable biomarkers for antibody-mediated rejection (ABMR) diagnosis. However, it is unclear whether DSA monitoring is necessary and could predict graft outcome after antirejection treatment. METHODS: We analyzed 28 non-sensitized kidney transplant patients with ABMR associated with de novo anti-human leukocyte antigen (HLA) DSA. Donor-specific antibody levels were measured by single antigen bead assays 12 months after antirejection therapy onset. Patients were placed in three groups according to their antirejection treatment: group I (n = 10), plasma exchange-Rituximab; group II (n = 8), Bortezomib; and group III (n = 10), optimization of maintenance immunosuppression. Half of the patients in group I demonstrated concomitant acute cellular rejection (ACR+). RESULTS: De novo DSA were mainly anti-DQ (60%). Anti-class I and anti-DR DSA disappeared after treatment in group I and remained negative during follow-up, whereas anti-DQ DSA persisted without any modulation. In contrast, class I-II HLA-DSA mean fluorescence intensity remained unchanged in groups II and III.Graft loss was observed in 80% and 20% of patients from group I (ACR+) and group III, respectively. One year after the ABMR treatment, a 16-mL/min decline in estimated glomerular filtration rate was observed in patients from group I (ACR-) and group III. Group II showed better outcomes with a mean estimated glomerular filtration rate decline of 6.4 mL/min. CONCLUSION: Modulation of DSA at and after treatment of ABMR did not correlate with graft outcome over a 12-month period.
BACKGROUND:Donor-specific antibodies (DSA) are considered as reliable biomarkers for antibody-mediated rejection (ABMR) diagnosis. However, it is unclear whether DSA monitoring is necessary and could predict graft outcome after antirejection treatment. METHODS: We analyzed 28 non-sensitized kidney transplant patients with ABMR associated with de novo anti-human leukocyte antigen (HLA) DSA. Donor-specific antibody levels were measured by single antigen bead assays 12 months after antirejection therapy onset. Patients were placed in three groups according to their antirejection treatment: group I (n = 10), plasma exchange-Rituximab; group II (n = 8), Bortezomib; and group III (n = 10), optimization of maintenance immunosuppression. Half of the patients in group I demonstrated concomitant acute cellular rejection (ACR+). RESULTS: De novo DSA were mainly anti-DQ (60%). Anti-class I and anti-DR DSA disappeared after treatment in group I and remained negative during follow-up, whereas anti-DQ DSA persisted without any modulation. In contrast, class I-II HLA-DSA mean fluorescence intensity remained unchanged in groups II and III.Graft loss was observed in 80% and 20% of patients from group I (ACR+) and group III, respectively. One year after the ABMR treatment, a 16-mL/min decline in estimated glomerular filtration rate was observed in patients from group I (ACR-) and group III. Group II showed better outcomes with a mean estimated glomerular filtration rate decline of 6.4 mL/min. CONCLUSION: Modulation of DSA at and after treatment of ABMR did not correlate with graft outcome over a 12-month period.
Authors: Meghan H Pearl; Anjali B Nayak; Robert B Ettenger; Dechu Puliyanda; Miguel Fernando Palma Diaz; Qiuheng Zhang; Elaine F Reed; Eileen W Tsai Journal: Pediatr Nephrol Date: 2016-04-05 Impact factor: 3.714
Authors: Alberto Mella; Ester Gallo; Maria Messina; Cristiana Caorsi; Antonio Amoroso; Paolo Gontero; Aldo Verri; Francesca Maletta; Antonella Barreca; Fabrizio Fop; Luigi Biancone Journal: World J Transplant Date: 2018-09-10