Persistence of low levels of alloantibody after desensitization in crossmatch-positive living-donor kidney transplantation

被引:89
|
作者
Gloor, JM
DeGoey, S
Ploeger, N
Gebel, H
Bray, R
Moore, SB
Dean, PG
Stegall, MD
机构
[1] Mayo Clin & Mayo Fdn, Dept Internal Med & Nephrol, Rochester, MN 55905 USA
[2] Mayo Clin, Dept Lab Med, Rochester, MN USA
[3] Emory Univ Hosp, Atlanta, GA 30322 USA
[4] Mayo Clin, Div Transplant Surg, Dept Surg, Rochester, MN USA
关键词
crossmatch; allantibody; plasmapheresis; immunoglobulin;
D O I
10.1097/01.tp.0000128516.82593.47
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: Desensitization protocols have been developed to allow successful kidney transplantation in sensitized recipients. However, a detailed analysis of the impact of these protocols on alloantibody has not been performed. Methods: We studied 12 living-donor kidney-transplant recipients with positive antihuman globulin-enhanced complement dependent cytotoxicity (AHG-CDC) crossmatches against their donors. Using a variety of crossmatch techniques and single-antigen flowbeads (SAFBs), we characterized the specificity and amount of alloantibody at baseline before desensitization, after desensitization (using plasmapheresis followed by 100 mg/kg intravenous immunoglobulin, and anti-CD20 antibody), and 4 months after transplantation (after splenectomy and on maintenance immunosuppression). Results: All 12 patients with a positive baseline AHG-CDC crossmatch were AHG-CDC crossmatch negative at the time of transplant (after desensitization). However, despite desensitization, the majority of patients had low-level donor-specific alloantibodies demonstrable on the day of transplantation by both flow crossmatch (FXM 8/12) and SAFBs (10/11). Four months after transplantation, no patient had a positive AHG-CDC crossmatch, but again the majority had persistent low levels of donor-specific alloantibodies by FXM (6/12) and SAFBs (9/11). No patient experienced hyperacute rejection, and the persistence of low levels of donor-specific alloantibodies did not correlate with the development of humoral rejection in the early posttransplant period. Conclusions: Despite desensitization, a majority of positive crossmatch transplant recipients demonstrate low levels of donor-specific alloantibodies both on the day of transplant and 4 months after transplantation. The impact of these antibodies appears to be minimal early after transplant, but their long-term significance bears further study.
引用
收藏
页码:221 / 227
页数:7
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