Acute humoral rejection in renal allograft recipients: I. Incidence, serology and clinical characteristics

Détails

ID Serval
serval:BIB_C5D09F3E51D5
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Acute humoral rejection in renal allograft recipients: I. Incidence, serology and clinical characteristics
Périodique
Transplantation
Auteur(s)
Crespo  M., Pascual  M., Tolkoff-Rubin  N., Mauiyyedi  S., Collins  A. B., Fitzpatrick  D., Farrell  M. L., Williams  W. W., Delmonico  F. L., Cosimi  A. B., Colvin  R. B., Saidman  S. L.
ISSN
0041-1337
Statut éditorial
Publié
Date de publication
03/2001
Peer-reviewed
Oui
Volume
71
Numéro
5
Pages
652-8
Notes
Journal Article
Research Support, Non-U.S. Gov't --- Old month value: Mar 15
Résumé
BACKGROUND: Acute rejection (AR) associated with de novo production of donor-specific antibodies (DSA) is a clinicopathological entity that carries a poor prognosis (acute humoral rejection, AHR). The aim of this study was to determine the incidence and clinical characteristics of AHR in renal allograft recipients, and to further analyze the antibodies involved. METHODS: During a 4-year period, 232 renal transplants (Tx) were performed at our institution. Assays for DSA included T and B cell cytotoxic and/or flow cytometric cross-matches and cytotoxic antibody screens (PRA). C4d complement staining was performed on frozen biopsy tissue. RESULTS: A total of 81 patients (35%) suffered at least one episode of AR within the first 3 months: 51 had steroid-insensitive AR whereas the remaining 30 had steroid-sensitive AR. No DSA were found in patients with steroid-sensitive AR. In contrast, circulating DSA were found in 19/51 patients (37%) with steroid-insensitive AR, and widespread C4d deposits in peritubular capillaries were present in 18 of these 19 (95%). In at least three cases, antibodies were against donor HLA class II antigens. DSA were not found in the remaining 32 patients but C4d staining was positive in 2 of 32. The DSA/C4d positive (n=18) and DSA/C4d negative (n=30) groups differed in pre-Tx PRA levels, percentage of re-Tx patients, refractoriness to antilymphocyte therapy, and outcome. Plasmapheresis and tacrolimus-mycophenolate mofetil rescue reversed rejection in 9 of 10 recipients with refractory AHR. CONCLUSION: More than one-third of the patients with steroid-insensitive AR had evidence of AHR, often resistant to antilymphocyte therapy. Most cases (95%) with DSA at the time of rejection had widespread C4d deposits in peritubular capillaries, suggesting a pathogenic role of the circulating alloantibody. Combined DSA testing and C4d staining provides a useful approach for the early diagnosis of AHR, a condition that often necessitates a more intensive therapeutic rescue regimen.
Mots-clé
Acute Disease Adult Antibodies/analysis/therapeutic use Antibody Formation Complement C4/analysis/therapeutic use *Complement C4b Drug Resistance Graft Rejection/drug therapy/*epidemiology/immunology/*physiopathology Humans Immunity, Cellular Incidence Kidney/immunology *Kidney Transplantation Middle Aged Peptide Fragments/analysis/therapeutic use Postoperative Period Steroids/therapeutic use Tissue Donors United States
Pubmed
Web of science
Création de la notice
29/01/2008 14:52
Dernière modification de la notice
20/08/2019 16:41
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