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2008, Number 4

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Gac Med Mex 2008; 144 (4)

Evidencia del impacto de los anticuerpos anti-HLA y anti-MICA en la pérdida del injerto renal

Morales-Buenrostro LE, Rodríguez-Romo R, Leo-Cervantes C, López M, Pérez-Garrido J, Uribe-Uribe N, Alberú-Gómez J

Language: Spanish
References: 26
Page: 315-322
PDF size: 69.67 Kb.


ABSTRACT

Background: HLA and MICA antibodies are increasingly associated with poorer graft survival. The aim of this study is to report the frequency of graft loss 2 years after the detection of HLA abs and MICA abs among a group of kidney transplant recipients.
Methods: We tested 196 patients with a functioning graft. Sera were screened for HLA and MICA IgG abs by Luminex, using the LABScreen Mixed, and LABScreen PRA. The sera were screened for MICA abs by Luminex.
Results: Of 196 kidney transplant recipients (mean age 36.7 years, 42% female), one hundred twenty four (63.3%) were negative to all tested abs, and 72 (36.7%) were positive for: HLA abs alone=34, MICA abs alone=29, and HLA+MICA abs=9. At a median followup of 20.5 (1.2-25.2) months, 8 patients lost their grafts due to biopsy-confirmed chronic allograft injury: 2/124 (1.6%) abnegative, and 6/72 (8.3%) ab-positive, with a significantly lower survival for the Ab-positive group (p=0.046, log-rank test).
Conclusions: The presence of circulating abs was associated with an increased risk of graft loss, and the coexistence of HLA and MICA absincreases the risk of graft loss.


REFERENCES

  1. Jeannet M, Pinn VW, Flax MH, Winn HJ, Russell PS. Humoral antibodies in renal allotransplantation in man. N Engl J Med 1970;282:111-117.

  2. Terasaki PI, Kreisler M, Mickey RM. Presensitization and kidney transplant failures. Postgrad Med J 1971;47:89-100.

  3. Halloran PF, Wadgymar A, Ritchie S, Falk J, Solez K, Srinivasa NS. The significance of the anti-class I antibody response. I. Clinical and pathologic features of anti-class I-mediated rejection. Transplantation 1990;49:85-91.

  4. Zhang Q, Liang LW, Gjertson DW, Lassman C, Wilkinson AH, Kendrick E, et al. Development of posttransplant antidonor HLA antibodies is associated with acute humoral rejection and early graft dysfunction. Transplantation 2005;79:591-598.

  5. Karpinski M, Rush D, Jeffery J, Exner M, Regele H, Dancea S, et al. Flow cytometric crossmatching in primary renal transplant recipients with a negative anti-human globulin enhanced cytotoxicity crossmatch. J Am Soc Nephrol 2001;12:2807-2814.

  6. Feucht HE, Schneeberger H, Hillebrand G, Burkhardt K, Weiss M, Beretz A, et al. Capillary deposition of C4d complement fragment and early graft loss. Kidney Int 1993;43:1333-1338.

  7. Crespo M, Pascual M, Tolkoff-Rubin N, Mauiyyedi S, Collins AB, Fitzpatrick D, et al. Acute humoral rejection in renal allograft recipients: incidence, serology, and clinical characteristics. Transplantation 2001;71:652-658.

  8. McKenna RM, Takemoto SK, Terasaki PI. Anti-HLA antibodies after solid organ transplantation. Transplantation 2000;69:319-326.

  9. Sumitran-Holgersson S, Wilczek HE, Holgersson J, Soderstrom K. Identification of the nonclassical HLA molecules, mica, as targets for humoral immunity associated with irreversible rejection of kidney allografts. Transplantation 2002;74:268-277.

  10. Mizutani K, Terasaki P, Rosen A, Esquenazi V, Miller J, Shih RN, et al. Serial ten-year follow-up of HLA and MICA antibody production prior to kidney graft failure. Am J Transplant 2005;5:2265-2272.

  11. Alberú J, Dib-Kuri A. Inmunología de los trasplantes. En: Aguirre-Rivero R, de la Garza-Villaseñor L, editores. Tratado de cirugía general. México: El Manual Moderno/Consejo Mexicano de Cirugía General; 2003. pp. 1315-1325.

  12. Bahram S, Bresnahan M, Geraghty DE, Spies T. A second lineage of mammalian major histocompatibility complex class I genes. Proc Natl Acad Sci USA 1994;91:6259-6263.

  13. Zwirner NW, Marcos CY, Mirbaha F, Zou Y, Stastny P. Identification of MICA as a new polymorphic alloantigen recognized by antibodies in sera of organ transplant recipients. Human Immunol 2000;61:917-924.

  14. Reed EF. Signal transduction via MHC molecules in endothelial and smooth muscle cells. Crit Rev Immunol 2003;23:109-128.

  15. Morales-Buenrostro LE, Buzo-Romero JM, de Leo C, López M, Ortiz- Arroyo VM, Pérez-Garrido J, et al. Prevalence of HLA antibodies and its impact on graft function in a group od kidney transplant recipients: a crosssectional study. Transplant Proc 2006;38:899-902.

  16. Terasaki PI, Ozawa M. Predicting kidney graft failure by HLA antibodies: a prospective trial. Am J Transplant 2003;4:438-443.

  17. Zou Y, Stastny P, Süsal C. Döhler B, Opelz G. Antibodies against MICA antigens and kidney-transplant rejection. N Engl J Med 2007;357:1293-1300.

  18. Lee PC, Terasaki PI, Takemoto SK, Lee PH, Hung CJ, Chen YL, et al. All chronic rejection failures of kidney transplant were preceded by development of HLA antibodies. Transplantation 2002;74:1192-1194.

  19. Terasaki PI, Ozawa M. Predictive value of HLA antibodies and serum creatinine in chronic rejection: results of a 2-year prospective trial. Transplantation 2005;80:1194-1197.

  20. Harris PE, Bian H, Reed EF. Induction of high affinity fibroblast growth factor receptor expression and proliferation in human endothelial cells by anti-HLA antibodies: a possible mechanism for transplant atherosclerosis. J Immunology 1997;159:5697-5704.

  21. Worthington JE, Martin S, Al-Husseini DM, Dyer PA, Johnson RWG. Posttransplantation production of donor HLA-specific antibodies as a predictor of renal transplant outcome. Transplantation 2003;75:1034-1040.

  22. Pascual M, Saidman S, Tolkoff-Rubin N, William WW, Mauiyyedi S, Duan JM, et al. Plasma exchange and tacrolimus-mycophenolate rescue for acute humoral rejection in kidney transplantation. Transplantation 1998;66:1460-1464.

  23. Theruvath TP, Saidman SL, Mauiyeddi S, Delmonico FL, Williams WW, Tolkoff-Rubin N, et al. Control of antidonor antibody production with tacrolimus and mycophenolate mofetil in renal allograft recipients with chronicrejection. Transplantation 2001;72:77-83.

  24. Akalin E, Pascual M. Sensitization after kidney transplantation. Clin J Am Soc Nephrol 2006;1:433-440.

  25. Salama AD, Delikouras A, Pusey CD, Cook HT, Bhangal G. Lechler RI, et al. Transplant accommodation in highly sensitized patients: a potential role for Bcl-xL and alloantibody. Am J Transplant 2001;1:260-269.

  26. Williams JM, Holzknecht ZE, Plummer TB, Lin SS, Brunn GJ, Platt JL. Acute vascular rejection and accommodation: divergent outcomes of the humoral response to organ transplantation. Transplantation 2004;78:1471- 1478.




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