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1.
Intravenous immunoglobulins and rituximab therapy for severe transplant glomerulopathy in chronic antibody‐mediated rejection: a pilot study 下载免费PDF全文
Thomas Bachelet Celine Nodimar Jean‐Luc Taupin Sebastien Lepreux Karine Moreau Delphine Morel Gwendaline Guidicelli Lionel Couzi Pierre Merville 《Clinical transplantation》2015,29(5):439-446
Outcome of patients with transplant glomerulopathy (TG) is poor. Using B‐cell targeting molecules represent a rational strategy to treat TG during chronic antibody‐mediated rejection. In this pilot study, 21 patients with this diagnosis received four doses of intravenous immunoglobulins and two doses of rituximab (IVIG/RTX group). They were retrospectively compared with a untreated control group of 10 patients. At 24 months post‐biopsy, graft survival was similar and poor between the treated and the untreated group, 47% vs. 40%, respectively, p = 0.69. This absence of response of IVIG/RTX treatment was observed, regardless the phenotype of TG. Baseline estimated glomerular filtration rate (eGFR) and decline in eGFR during the first six months after the treatment were risk factors associated with 24‐month graft survival. The IVIG/RTX therapy had a modest effect on the kinetics of donor‐specific alloantibodies at M24, compared to the untreated group, not associated with an improvement in graft survival. The mean number of adverse events per patient was higher in the IVIG/RTX group than in the control group (p = 0.03). Taken together, IVIG/RTX treatment for severe TG during chronic antibody‐mediated rejection does not seem to change the natural history of TG and is associated with a high incidence of adverse events. 相似文献
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Donor‐specific HLA antibody‐mediated complement activation is a significant indicator of antibody‐mediated rejection and poor long‐term graft outcome during lung transplantation: a single center cohort study 下载免费PDF全文
Antoine Roux Kimberly A. Thomas Edouard Sage Caroline Suberbielle‐Boissel Laurence Beaumont‐Azuar Francois Parquin Morgan Le Guen Nicholas Harre Abdul Monem Hamid Elaine F. Reed 《Transplant international》2018,31(7):761-772
Complement‐mediated allograft injury, elicited by donor‐specific HLA antibodies (DSA ), is a defining pathophysiological characteristic of allograft damage. We aimed to study DSA ‐induced complement activation as a diagnostic marker of antibody‐mediated rejection (AMR ) and a risk stratification tool for graft loss in the context of lung transplantation (LT ). We identified 38 DSA ‐positive patients whose serum samples were submitted for C3d deposition testing via the C3d assay. Among these 38 patients, 15 had AMR (DSAP osAMRP os). Results were reported for each patient as the C3d ratio for each DSA , the immunodominant DSA , and the C3d ratio for all DSA present in a sample (C3d ratioSUM ). DSAP osAMRP os patients had higher C3d ratioSUM values (58.66 (?1.32 to 118.6) vs. 1.52 (0.30 to 2.74), P = 0.0016) and increased immunodominant C3d ratios (41.87 (1.72 to 82.02) vs. 0.69 (0.21 to 1.19), P = 0.001) when compared with DSAP osAMRN eg patients. Specificity and calculated positive predictive value of the immunodominant C3d ratio and BCM sum tests for AMR diagnosis were both 100% (CI = 17.4–100) in this cohort. Worst graft survival was associated with both immunodominant C3d ratio ≥4 or C3d ratioSUM ≥10 or BCM sum >7000, suggesting that the antibody composition and/or strength are the principal determinants of an HLA DSA 's capacity to activate complement. 相似文献
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Fengshi Chen Aya Miyagawa‐Hayashino Kimiko Yurugi Naomi Chibana Tetsu Yamada Masaaki Sato Akihiro Aoyama Shunji Takakura Toru Bando Hiroshi Date 《Transplant international》2014,27(2):e8-e12
Living‐donor lobar lung transplantation (LDLLT) is an established therapy for patients with end‐stage lung disease, but living‐donor lobar lung retransplantation (re‐LDLLT) is rarely reported. We previously reported a case of unilateral antibody‐mediated rejection after LDLLT in the presence of newly formed donor‐specific antibodies against a right‐lobe donor. The same patient developed contralateral bronchiolitis obliterans, resulting in bilateral bronchiolitis obliterans, but re‐LDLLT was successful. Pathological findings of the explanted lungs were consistent with the clinical course of the patient. One year after re‐LDLLT, the patient is doing well without any anti‐human leukocyte antigen antibodies. Four lobes from four different donors were transplanted in this patient. The first two lobes were rejected eventually, but the two lobes implanted later presented no signs of rejection at least for 1 year after the transplant. Herein, we report this rare case and compare the clinical course and pathological findings. 相似文献
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Determining donor‐specific antibody C1q‐binding ability improves the prediction of antibody‐mediated rejection in human leucocyte antigen‐incompatible kidney transplantation 下载免费PDF全文
Jorge Malheiro Sandra Tafulo Leonídio Dias La Salete Martins Isabel Fonseca Idalina Beirão António Castro‐Henriques António Cabrita 《Transplant international》2017,30(4):347-359
Detrimental impact of preformed donor‐specific antibodies (DSAs) against human leucocyte antigens on outcomes after kidney transplantation are well documented, however, the value of their capacity to bind complement for predicting antibody‐mediated rejection (AMR) and graft survival still needs to be confirmed. We aimed to study DSA characteristics (strength and C1q binding) that might distinguish harmful DSA from clinically irrelevant ones. We retrospectively studied 60 kidney‐transplanted patients with preformed DSA detected by single antigen bead (SAB) assays (IgG and C1q kits), from a cohort of 517 kidney graft recipients (124 with detectable anti‐HLA antibodies). Patients were divided into DSA strength (MFI < vs. ≥ 15 000) and C1q‐binding ability. AMR frequency was high (30%) and it increased with DSA strength (P = 0.002) and C1q+ DSA (P < 0.001). The performance of DSA C1q‐binding ability as a predictor of AMR was better than DSA strength (diagnostic odds ratio 16.3 vs. 6.4, respectively). Furthermore, a multivariable logistic regression showed that C1q+ DSA was a risk factor for AMR (OR = 16.80, P = 0.001), while high MFI DSAs were not. Graft survival was lower in high MFI C1q+ DSA in comparison with patients with C1q? high or low MFI DSA (at 6 years, 38%, 83% and 80%, respectively; P = 0.001). Both DSA strength and C1q‐binding ability assessment seem valuable for improving pretransplant risk assessment. Since DSA C1q‐binding ability was a better predictor of AMR and correlated with graft survival, C1q‐SAB may be a particularly useful tool. 相似文献
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Nele Kirsten Kanzelmeyer Petra Zürbig Harald Mischak Jochen Metzger Alexander Fichtner Kristzina Heindl Ruszai Tomas Seemann Matthias Hansen Simone Wygoda Kai Krupka Burkhard Tnshoff Anette Melk Lars Pape 《Transplant international》2019,32(1):28-37
Chronic antibody‐mediated rejection (cABMR) is the main cause of long‐term renal graft loss. Late‐stage diagnosis is made by detecting donor‐specific antibodies (DSA) in blood combined with typical histomorphological lesions in renal allografts. There is a need for noninvasive biomarkers for cABMR that might permit screening and earlier diagnosis. In a case control study of 24 pediatric renal transplant recipients, urine samples were analyzed using capillary electrophoresis and mass spectrometry. Patients were matched with 36 pediatric renal transplant patients without cABMR. Statistical analysis used the nonparametric Wilcoxon test to identify 79 significant biomarkers, which were combined to a support vector machine‐based classifier. After validation in an independent test cohort of eight pediatric patients with and 12 without cABMR, the area under the receiver operating characteristic (ROC) curve (AUC) for detection of cABMR was 0.92 (95% CI 0.71–0.99) with a sensitivity of 100% (95% CI 63–100%) and a specificity of 75% (95% CI 43–95%). Combining this classifier with the urinary proteomic marker CKD273 improved the detection of patients with cABMR with misclassification in only 2/20 of the patients. These data indicate that a biomarker pattern derived from urinary proteomics allows the detection of cABMR in pediatric renal transplant recipients with high sensitivity and moderate specificity. 相似文献
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Difference in outcomes after antibody‐mediated rejection between abo‐incompatible and positive cross‐match transplantations 下载免费PDF全文
Lionel Couzi Miriam Manook Ranmith Perera Olivia Shaw Zubir Ahmed Nicos Kessaris Anthony Dorling Nizam Mamode 《Transplant international》2015,28(10):1205-1215
Graft survival seems to be worse in positive cross‐match (HLAi) than in ABO‐incompatible (ABOi) transplantation. However, it is not entirely clear why these differences exist. Sixty‐nine ABOi, 27 HLAi and 10 combined ABOi+HLAi patients were included in this retrospective study, to determine whether the frequency, severity and the outcome of active antibody‐mediated rejection (AMR) were different. Five‐year death‐censored graft survival was better in ABOi than in HLAi and ABOi+HLAi patients (99%, 69% and 64%, respectively, P = 0.0002). Features of AMR were found in 38%, 95% and 100% of ABOi, HLAi and ABOi+HLAi patients that had a biopsy, respectively (P = 0.0001 and P = 0.001). After active AMR, a declining eGFR and graft loss were observed more frequently in HLAi and HLAi+ABOi than in ABOi patients. The poorer prognosis after AMR in HLAi and ABOi+HLAi transplantations was not explained by a higher severity of histological lesions or by a less aggressive treatment. In conclusion, ABOi transplantation offers better results than HLAi transplantation, partly because AMR occurs less frequently but also because outcome after AMR is distinctly better. HLAi and combined ABOi+HLAi transplantations appear to have the same outcome, suggesting there is no synergistic effect between anti‐A/B and anti‐HLA antibodies. 相似文献
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De novo donor‐specific antibody following BK nephropathy: The incidence and association with antibody‐mediated rejection 下载免费PDF全文
Wisit Cheungpasitporn Walter K. Kremers Elizabeth Lorenz Hatem Amer Fernando G. Cosio Mark D. Stegall Manish J. Gandhi Carrie A. Schinstock 《Clinical transplantation》2018,32(3)
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Muhammad A. Rafiq Graciela De Boccardo Bernd Schröppel Jonathan S. Bromberg Vinita Sehgal Rajani Dinavahi Barbara Murphy Enver Akalin 《Clinical transplantation》2009,23(6):951-957
Abstract: Introduction: The aim of this study is to investigate the prevalence, predictors, and clinical outcomes of acute antibody‐mediated rejection (AAMR). Methods: Retrospective analysis of 833 adult patients who received kidney transplantation between 1/1/2001 and 8/15/2007. Results: The prevalence of AAMR and acute cellular rejection was 2% and 8.2%, respectively. Eight patients had type I, seven type II, and two type III AAMR. All patients had at least one strong donor‐specific anti‐HLA antibodies (DSA) with a median fluorescence intensity (MFI) value of over 6000 and the mean number of strong DSAs was 2.0 ± 0.7. Fifteen of 17 patients received pre‐transplant desensitization treatment. During a median 28 months of follow‐up (range: 12–38 months), two patients died (88% patient survival), and nine lost their allografts (35% graft survival). While all type I AAMR patients responded to treatment, all type III patients, and four of seven patients with type II AAMR lost their allografts earlier, and three type II AAMR patients later due to transplant glomerulopathy. Conclusions: AAMR is mainly seen in patients with pre‐transplant strong DSAs. There is a striking difference in clinical outcomes of AAMR that types II and III AAMR patients have poor prognosis compared to type I AAMR patients. 相似文献
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Michela Cioni Arcangelo Nocera Augusto Tagliamacco Sabrina Basso Annalisa Innocente Iris Fontana Alberto Magnasco Antonella Trivelli Catherine Klersy Antonella Gurrado Miriam Ramondetta Stella Boghen Laura Catenacci Enrico Verrina Giacomo Garibotto Gian Marco Ghiggeri Massimo Cardillo Fabrizio Ginevri Patrizia Comoli 《Transplant international》2019,32(1):38-48
Current research is focusing on identifying bioclinical parameters for risk stratification of renal allograft loss, largely due to antibody‐mediated rejection (AMR). We retrospectively investigated graft outcome predictors in 24 unsensitized pediatric kidney recipients developing HLA de novo donor‐specific antibodies (dnDSAs), and treated for late AMR with plasmapheresis + low‐dose IVIG + Rituximab or high‐dose IVIG + Rituximab. Renal function and DSA properties were assessed before and longitudinally post treatment. The estimated GFR (eGFR) decline after treatment was dependent on a negative % eGFR variation in the year preceding treatment (P = 0.021) but not on eGFR at treatment (P = 0.74). At a median follow‐up of 36 months from AMR diagnosis, 10 patients lost their graft. Altered eGFR (P < 0.001) and presence of C3d‐binding DSAs (P = 0.005) at treatment, and failure to remove DSAs (P = 0.01) were negatively associated with graft survival in the univariable analysis. Given the relevance of DSA removal for therapeutic success, we analyzed antibody properties dictating resistance to anti‐humoral treatment. In the multivariable analysis, C3d‐binding ability (P < 0.05), but not C1q‐binding, and high mean fluorescence intensity (P < 0.05) were independent factors characterizing DSAs scarcely susceptible to removal. The poor prognosis of late AMR is related to deterioration of graft function prior to treatment and failure to remove C3d binding and/or high‐MFI DSAs. 相似文献
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Postoperative rebound of antiblood type antibodies and antibody‐mediated rejection after ABO‐incompatible living‐related kidney transplantation 下载免费PDF全文
Hideki Ishida Tsunenori Kondo Tomokazu Shimizu Taiji Nozaki Kazunari Tanabe 《Transplant international》2015,28(3):286-296
The purpose of this study is to examine whether postoperative antiblood type antibody rebound is attributed to kidney allograft rejection in ABO blood type‐incompatible (ABO‐I) living‐related kidney transplantation (KTx). A total of 191 ABO‐I recipients who received ABO‐I living‐related KTx between 2001 and 2013 were divided into two groups: Group 1 consisted of low rebound [(≦1:32), N = 170] and Group 2 consisted of high rebound [(≧1:64), N = 21], according to the levels of the rebounded antiblood type antibodies within 1 year after transplantation. No prophylactic treatment for rejection was administered for elevated antiblood type antibodies, regardless of the levels of the rebounded antibodies. Within 1 year after transplantation, T‐cell‐mediated rejection was observed in 13 of 170 recipients (13/170, 8%) in Group 1 and in 2 of 21 recipients (2/21, 10%) in Group 2 (Groups 1 vs. 2, P = 0.432). Antibody‐mediated rejection was observed in 15 of 170 recipients (15/170, 9%) and 2 of 21 recipients (2/21, 10%) in Groups 1 and 2, respectively (P = 0.898). In this study, we found no correlation between the postoperative antiblood type antibody rebound and the incidence of acute rejection. We concluded that no treatment is necessary for rebounded antiblood type antibodies. 相似文献
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Ashwin K. Ravichandran Joel D. Schilling Eric Novak John Pfeifer Gregory A. Ewald Susan M. Joseph 《Clinical transplantation》2013,27(6):961-967
Antibody‐mediated rejection (AMR) after cardiac transplantation is associated with significant mortality, and the optimal treatment of this condition is poorly defined. Rituximab has been used successfully for the treatment for antibody‐mediated diseases; however, its role in AMR is unclear. We review our experience with rituximab in patients with cardiac allograft AMR. We conducted a retrospective analysis of cardiac transplant patients with a diagnosis of AMR from 2001 to 2011. Inclusion criteria were clinical suspicion of rejection with the presence of C4d complement staining on endomyocardial biopsy and the absence of cellular rejection of grade 2R or greater. Patients were divided into Rituximab and NoRituximab groups. The primary endpoint was all‐cause mortality. Secondary endpoints were infection, change in ejection fraction (EF), and rehospitalization. Thirty‐three patients met inclusion criteria, of whom 13 received rituximab and 20 did not. Baseline characteristics were similar between groups. Kaplan–Meier curves for a three‐yr follow‐up period demonstrate improved survival in the Rituximab group (p = 0.0089). There were no differences in secondary endpoints. We found that rituximab therapy was associated with improved survival in cardiac allograft AMR. Further prospective, randomized studies in larger patient populations are needed to confirm this finding and to define ideal timing for rituximab administration. 相似文献
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Compartment‐specific expression of natural killer cell markers in renal transplantation: immune profile in acute rejection 下载免费PDF全文
Daniela Cristina dos Santos Erika Fernandes Campos Niels Olsen Saraiva Câmara Daisa Silva Ribeiro David Denise Maria Avancini Costa Malheiros 《Transplant international》2016,29(4):443-452
Natural killer (NK) cells have been implicated in graft dysfunction. Here, we formulated hypothesis that distinct patterns of expression NK cells markers correlated with acute rejection in kidney transplantation. Therefore, we studied the pattern of NK cell markers CD56, CD57, and CD16 in different compartments of biopsies obtained from recipients diagnosed with acute graft rejection, with or without donor‐specific antibodies (DSA). DSA‐negative biopsies‐from patients with acute T‐cell mediated rejection (aTCMR) had an increased expression of CD56+ and CD57+ cells (P = 0.004 and P = 0.001) in the interstitial compartment in comparison with DSA‐positive biopsies from patients acute antibody‐mediated rejection (aABMR) with (aABMR C4d+) and without C4d deposition (aABMR C4d‐). CD16+ cells was increased (P = 0.03) in the glomerular compartment in DSA‐positive biopsies. We assume that CD16+ expression and antibody‐dependent cellular cytotoxicity (ADCC) in microvascular injury can be associated with aABMR. IFN‐γ release from cytoplasmic granules of NK cell could be associated with aTCMR. Our findings suggest that NK cells need to be carefully evaluated because variations in NK cell marker expression might imply the involvement of different immune system pathways in graft rejection. 相似文献
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We sought to clarify the controversial issue of whether detecting low‐level anti‐donor‐specific HLA antibody (HLA‐DSA) by single‐antigen flow‐bead assay (SAFB) may have a potential role in reducing acute and chronic antibody‐mediated rejection (AMR). We retrospectively studied the preoperative serum of ABO‐compatible living kidney transplantation recipients transplanted between 2001 and 2004 by SAFB using a Luminex platform. HLA‐DSA was detected only by SAFB in 24 patients, although all of them showed negative T‐cell and B‐cell complement‐dependent cytotoxicity (CDC) crossmatches. The HLA‐DSA patients went on to have surprisingly high levels of acute and chronic AMR despite being only weakly sensitized (acute AMR, 33.3%; chronic AMR, 41.7%). After 2005, we implemented SAFB routinely and any patient having a positive HLA‐DSA was considered to be a desensitization candidate. The 52 patients found to have HLA‐DSA underwent kidney transplantation after prior treatment with a single dose of rituximab (RIT) and three or four sessions of double‐filtration plasmapheresis (DFPP) in addition to regimens commonly used between 2001 and 2004. After 2005, there was a significant reduction in the occurrence of acute and chronic AMR (acute AMR, 4.7%, P < 0.001; chronic AMR, 4.7%, P < 0.001). The 5‐year graft survival rate also improved after implementing SAFB (83.3–98.1%, P = 0.032). The RIT/DFPP‐induction protocol may improve graft survival even in patients with low‐level DSA. 相似文献
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Kazuho Honda Shigeru Horita Daisuke Toki Sekiko Taneda Kosaku Nitta Motoshi Hattori Kazunari Tanabe Satoshi Teraoka Hideaki Oda Yutaka Yamaguchi 《Clinical transplantation》2011,25(2):191-200
Honda K, Horita S, Toki D, Taneda S, Nitta K, Hattori M, Tanabe K, Teraoka S, Oda H, Yamaguchi Y. De novo membranous nephropathy and antibody‐mediated rejection in transplanted kidney.Clin Transplant 2011: 25: 191–200. © 2010 John Wiley & Sons A/S. Abstract: Background: The etiology of de novo membranous nephropathy (MN) after kidney transplantation is still uncertain. Immunological response to various allograft antigens is speculated to be a candidate for the etiology. Methods: Seventeen patients with post‐transplant de novo MN were studied clinically and pathologically in comparison with control post‐transplant patients without MN. Double immunofluorescent staining was performed to identify the presence of donor‐specific human leukocyte antigen (HLA) combined with IgG in the deposits on glomerular capillary walls. Results: De novo MN occurs in relatively late period after transplantation (102.1 ± 68.3 months), presenting various degree of proteinuria. Histological findings associated with antibody‐mediated rejection (AMR), such as peritubular capillaritis and C4d deposition in peritubular capillary, were more frequently observed in the patients with de novo MN than the non‐MN control patients. Donor‐specific antibody (DSA) was detected in five patients at the time of biopsy. In one case of de novo MN with DSA, a donor‐derived HLA was identified in the subepithelial deposits on the glomerular capillary walls combined with IgG deposition. Conclusions: DSA and AMR might play some roles for the pathogenesis in some patients with de novo MN after kidney transplantation. 相似文献
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Tocilizumab for the treatment of chronic antibody mediated rejection in kidney transplant recipients
Pascale Khairallah Shelief Robbins-Juarez Shefali Patel Vaqar Shah Katherine Toma Hilda Fernandez Geoffrey K. Dube Kristen King Sumit Mohan Syed Ali Husain Heather Morris Russell John Crew 《Clinical transplantation》2023,37(1):e14853
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Outcomes and risk stratification for late antibody‐mediated rejection in recipients of ABO‐incompatible kidney transplants: a retrospective study 下载免费PDF全文
Bonnie E. Lonze Sunjae Bae Edward S. Kraus Mary J. Holechek Karen E. King Nada Alachkar Fizza F. Naqvi Nabil N. Dagher Adnan Sharif Niraj M. Desai Dorry L. Segev Robert A. Montgomery 《Transplant international》2017,30(9):874-883
The required intensity of monitoring for antibody‐mediated rejection (AMR) after of ABO‐incompatible (ABOi) kidney transplantation is not clearly formulized. We retrospectively evaluated a single‐center cohort of 115 ABO‐incompatible (ABOi) kidney transplant recipients, of which 32% were also HLA incompatible (ABOi/HLAi) with their donors. We used an adjusted negative binomial model to evaluate risk factors for late AMR. Using this model, we risk‐stratified patients into high‐ and low‐risk groups for the development of late AMR; 26% of patients had at least one AMR episode; 49% of AMR episodes occurred within 30‐days after transplant and were considered early AMR. Patients with an early AMR episode had a 5.5‐fold greater incidence of developing late AMR [IRR = 5.5, (95% CI: 1.5–19.3), P = 0.01]. ABOi/HLAi recipients trended toward increased late AMR risk [IRR = 1.9, (95% CI: 0.5–6.6), P = 0.3]. High‐risk recipients (those with an early AMR or those who were ABOi/HLAi) had a sixfold increased incidence of late AMR [IRR = 6.3, (95% CI: 1.6–24.6), P = 0.008] versus low‐risk recipients. The overall incidence of late AMR was 20.8% vs. 1.5% in low‐risk recipients. Changes in anti‐A/B titer did not correlate with late AMR (IRR = 0.9 per log titer increase, P = 0.7). This risk‐stratification scheme uses information available within 30 days of ABOi transplantation to determine risk for late AMR and can help direct longitudinal follow‐up for individual patients. 相似文献
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Outcome of the risk‐stratified desensitization protocol in donor‐specific antibody‐positive living kidney transplant recipients: a retrospective study 下载免费PDF全文
Daigo Okada Masayoshi Okumi Yoichi Kakuta Kohei Unagami Junpei Iizuka Toshio Takagi Hideki Ishida Kazunari Tanabe 《Transplant international》2018,31(9):1008-1017
Acceptable outcomes of donor‐specific antibody (DSA)‐positive living kidney transplantation (LKT) have recently been reported. However, LKT in crossmatch (XM)‐positive patients remains at high‐risk and requires an optimal desensitization protocol. We report our intermediate‐term outcomes of XM‐positive LKT vs. XM‐negative LKT in patients who underwent LKT between January 2012 and June 2015 in our institution. The rate of acute antibody‐mediated rejection (ABMR) within 90 days postoperation, graft function, and patient, and graft survival rates at 4 years were investigated. Patients were divided into three groups: XM?DSA? (n = 229), XM?DSA+ (n = 36), and XM + DSA+ (n = 15). The XM + DSA+ group patients underwent desensitization with high‐dose intravenous immunoglobulin, plasmapheresis, and rituximab. The rates of ABMR within 90 days in the XM?DSA?, XM?DSA+, and XM + DSA+ groups were 1.3%, 9.4%, and 60.0%, respectively (P < 0.001). There were no significant differences in the graft function throughout the observational period, the 4‐year patient or graft survival rates among three groups. This study showed that intermediate‐term outcomes of XM‐positive LKT were comparable to XM‐negative LKT. However, our current desensitization protocol cannot avert ABMR within 90 days, and XM positivity is still a significant risk factor for ABMR. Further refinement of the current desensitization regimen is required. 相似文献
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De novo DQ donor‐specific antibodies are associated with worse outcomes compared to non‐DQ de novo donor‐specific antibodies following heart transplantation 下载免费PDF全文
Robert Townsend Cole Jonathan Gandhi Robert A. Bray Howard M. Gebel Alanna Morris Andrew McCue Michael Yin S. Raja Laskar Wendy Book Maan Jokhadar Andrew Smith Duc Nguyen J. David Vega Divya Gupta 《Clinical transplantation》2017,31(4)