Donor-specific antibodies development in renal living-donor receptors: Effect of a single cohort

被引:2
|
作者
Andrade-Sierra, Jorge [1 ,2 ,3 ]
Cueto-Manzano, Alfonso M. [4 ]
Rojas-Campos, Enrique [4 ]
Cardona-Munoz, Ernesto [2 ,3 ]
Cerrillos-Gutierrez, Jose, I [1 ,2 ]
Gonzalez-Espinoza, Eduardo [1 ,2 ]
Evangelista-Carrillo, Luis A. [1 ,2 ]
Medina-Perez, Miguel [1 ,2 ]
Jalomo-Martinez, Basilio [1 ,2 ]
Nieves Hernandez, Juan [1 ,2 ]
Pazarin-Villasenor, Leonardo [1 ,2 ]
Mendoza-Cerpa, Claudia A. [1 ,2 ]
Gomez-Navarro, Benjamin [1 ,2 ]
Miranda-Diaz, Alejandra G. [3 ]
机构
[1] Mexican Inst Social Secur, Natl Western Med Ctr, Specialties Hosp, Dept Nephrol, Guadalajara, Jalisco, Mexico
[2] Mexican Inst Social Secur, Natl Western Med Ctr, Specialties Hosp, Organ Transplant Unit, Guadalajara, Jalisco, Mexico
[3] Univ Guadalajara, Univ Hlth Sci Ctr, Dept Physiol, Guadalajara, Jalisco, Mexico
[4] Mexican Inst Social Secur, Natl Western Med Ctr, Specialties Hosp, Med Res Unit Renal Dis, Guadalajara, Jalisco, Mexico
关键词
acute rejection; donor-specific antibodies; immunosuppression; renal transplantation; EARLY STEROID WITHDRAWAL; EARLY CORTICOSTEROID WITHDRAWAL; KIDNEY-TRANSPLANT RECIPIENTS; HLA ANTIBODIES; MYCOPHENOLATE-MOFETIL; CALCINEURIN INHIBITOR; LONG-TERM; MEDIATED REJECTION; GRAFT FAILURE; ANTI-HLA;
D O I
10.1177/20587384211000545
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Minimization in immunosuppression could contribute to the appearance the donor-specific HLA antibodies (DSA) and graft failure. The objective was to compare the incidence of DSA in renal transplantation (RT) in recipients with immunosuppression with and without steroids. A prospective cohort from March 1st, 2013 to March 1st, 2014 and follow-up (1 year), ended in March 2015, was performed in living donor renal transplant (LDRT) recipients with immunosuppression and early steroid withdrawal (ESW) and compared with a control cohort (CC) of patients with steroid-sustained immunosuppression. All patients were negative cross-matched and for DSA pre-transplant. The regression model was used to associate the development of DSA antibodies and acute rejection (AR) in subjects with immunosuppressive regimens with and without steroids. Seventy-seven patients were included (30 ESW and 47 CC). The positivity of DSA class I (13% vs 2%; P < 0.05) and class II (17% vs 4%, P = 0.06) antibodies were higher in ESW versus CC. The ESW tended to predict DSA class II (RR 5.7; CI (0.93-34.5, P = 0.06). T-cell mediated rejection presented in 80% of patients with DSA class I (P = 0.07), and 86% with DSA II (P = 0.03), and was associated with DSA class II, (RR 7.23; CI (1.2-44), P = 0.03). ESW could favor the positivity of DSA. A most strictly monitoring the DSA is necessary for the early stages of the transplant to clarify the relationship between T-cell mediated rejection and DSA.
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页数:8
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