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1.
S. Querido A. Weigert T. Adragão J. Henriques R. Birne P. Matias C. Jorge C. Nascimento M. Bruges D. Machado 《Transplantation proceedings》2018,50(3):723-727
Introduction
HLA-sensitized patients are penalized both in the access to kidney transplantation (KT) and, once transplanted, in the incidence of rejections and long-term allograft survival despite aggressive induction and maintenance therapy.Methods
This study retrospectively evaluates the impact of combining T- and B-cell–depleting agents and intravenous immunoglobulin for induction therapy in 45 highly sensitized KT patients (anti-panel reactive antibodies >60%, positive flow cytometry crossmatch or donor specific antibodies at the time of transplantation). The outcome data included the occurrence of biopsy-proven acute rejection, new-onset proteinuria, development of leukopenia, incidence of poliomavirus infection (BK or JC virus), fungal or bacterial infection after KT, de novo neoplasia, graft function, graft loss, or death with functioning KT.Results
The average panel reactive antibody was 62.5%; 41 patients (91.1%) had ≥3 HLA mismatches with the donor and 91.1% of patients had class I or II anti-HLA antibodies. Fourteen patients (31.1%) presented pre-KT donor-specific antibodies and 6 patients (13.3%) had a positive flow cytometry cross-match at the time of transplantation. The incidence of acute rejection in the first 6 months was 24.4% and the cumulative incidence was 37.8%. Two patients were diagnosed with leukopenia in the first 6 months after KT. Two patients (4.5%) had cytomegalovirus disease, 17 patients (37.8%) were diagnosed with bacterial infections. Cutaneous neoplasms were identified in 5 patients (11.1%) and solid tumors in 4 (8.9%). The death-censored graft survival was 100% in the first 6 months and 93.5% at the last evaluation. Patient survival in the same periods was 97.8% and 93.3%, respectively.Conclusions
Induction immunosuppressive therapy with intravenous immunoglobulin and rituximab is effective; outcomes demonstrate an excellent patient and allograft survival and allograft function over the follow-up period. 相似文献2.
K. Letachowicz T. Królicki K. Bardowska A. Drabik K. Zajdel D. Kamińska K. Madziarska M. Banasik O. Mazanowska M. Krajewska M. Klinger 《Transplantation proceedings》2018,50(6):1855-1857
Introduction
The prevalence of hypertension in renal graft recipients is high. It was postulated that central arteriovenous anastomosis may significantly reduce blood pressure. This preliminary study evaluates the impact of functioning arteriovenous fistula (AVF) on blood pressure control and renal allograft function.Materials and Methods
One hundred sixty-two previously hemodialyzed kidney transplant recipients (108 males, 54 females, aged 52.7 ± 13.2 years, mean 6.9 ± 5.1 years after transplantation), who had scheduled visits in the first two weeks of March 2015, were included in the study. The recipients were divided into two groups depending on AVF function (65 AVF+ and 97 AVF-).Results
Functioning AVF was more prevalent in males than females (47.2 % vs 25.9 %, P = .009). Both groups presented similar allograft function despite the fact that interval from transplantation to examination day in the AVF+ group was significantly shorter than in the AVF- group (5.2 ± 5.3 vs 8.1± 4.5 years; P < .001). The mean systolic blood pressure (135.0 ± 17.0 vs 138.7 ± 14.1 mm Hg, P = .13) was similar in both study groups, but diastolic blood pressure in the AVF+ group was lower than in the AVF- group (80.0 ± 7.0 vs and 83.7 ± 9.2 mm Hg, P = .006). The proportion of patients with diastolic blood pressure >80 mm Hg was significantly higher in patients without functioning AVF (35 % in the AVF- group vs 20 % in the AVF+ group, P= .038). In multivariate analysis, AVF presence was the only factor significantly influencing a diastolic blood pressure with odds ratio 0.43 (95% CI 0.19–0.99, P = .048), which supports AVF as a potentially positive influence on blood pressure control.Conclusions
The presence of AVF in renal transplant recipients was associated with a slight decrease in diastolic blood pressure without clear effect on renal function. 相似文献3.
M. Martínez Díaz A. Torío Ruíz I. Lorenzo González R. Rada Martínez F. Llamas Fuentes C. Gonzalvo Díaz B.J. Cabezuelo Rodríguez F.J. Centellas Pérez J. Ontañón Rodríguez C. Gómez Roldán 《Transplantation proceedings》2018,50(2):546-549
Background
Our objective in this study was to determine the effects of early renal transplantectomy on patients and the production of anti–human leukocyte antigen (anti-HLA) antibodies.Methods
Between January 2003 and May 2017, we analyzed a group of patients for the presence of specific HLA class I and/or II donor-specific antibodies (DSA), their panel-reactive antibodies (PRA), and the time period in which the antibodies were still detectable after transplantectomy.Results
Anti-HLA antibodies were detected in 60.8% of patients, 60.8% and 52.2% of those patients had anti-class I and anti-class II antibodies, respectively. DSA were detected in 91.7% of the anti–HLA class I patients. Class II DSA were detected all of the patients with anti–HLA class II antibodies. The average (mean ± SD) PRA levels in our patients after transplantectomy was 60 ± 34% in class I and 63 ± 36% in class II.Conclusion
Anti-HLA antibodies can be detected well after transplantectomy. Even if the kidney allograft had been transplanted for only a short time, when the intensity of immunosuppression was the highest, many patients developed anti-HLA antibodies. The patients who continued with immunosuppression after transplantectomy did not develop anti-HLA antibodies. 相似文献4.
K. Nowańska P. Donizy K. Kościelska-Kasprzak D. Kamińska M. Krajewska O. Mazanowska K. Madziarska S. Zmonarski P. Chudoba B. Małkiewicz A. Hałoń M. Klinger M. Banasik 《Transplantation proceedings》2018,50(6):1760-1764
Background
The role of non-HLA antibodies named antiendothelin A receptor antibodies is potentially significant but not established. The significance of the endothelin A receptor (ETAR) and its expression in renal biopsy has not been defined. We decided to evaluate the presence and relevance of ETARs in renal transplant biopsy for cause.The aim of our study was to evaluate the immunoreactivity of the ETAR and its significance in patients who had a renal transplant biopsy due to deterioration of transplant function (biopsy for cause) with detailed characterization of staining in small and intermediate arteries of renal transplant biopsies.Methods
Immunohistochemical expression of ETARs was analyzed in 162 renal transplant biopsies. Microscopic evaluation of ETAR expression (polyclonal antibody) was performed on paraffin sections. ETAR expression was analyzed in renal blood vessels (small and intermediate arteries) based on three-step scale.Results
We analyzed 154 patients who had renal allograft biopsy between 6 days and 24 years (median 597 days) after transplantation. Positive staining of ETAR in small and intermediate arteries was noticed in 9 patients. Among these patients, 4 had early biopsies (<3 months after transplantation), all developed acute tubular necrosis, and 1 developed additionally acute humoral rejection. Further, 4 patients had late biopsy (1-8 years after transplantation) and all developed characteristics of antibody mediated rejection. Lastly, 1 patient had no characteristic changes in the biopsy 4 months after transplantation. Graft loss 1 year after biopsy was higher in patients who were ETAR-positive but statistical significance was not achieved.Conclusions
The expression of endothelin receptors in renal blood vessels (small and intermediate arteries) seems to be important in diagnosis of damage during acute tubular necrosis and antibody-mediated rejection. 相似文献5.
Objective
There are no specific recommendations for therapeutic plasma exchange (TPE) in children after renal transplantation. The purpose of this study was to report the experience with TPE in a pediatric transplant setting.Materials and Methods
59 patients (mean age 12.5 ± 4.5 years) undergoing renal transplantation. Indications for TPE included the recurrence of nephrotic syndrome (NS; n = 30) and atypical hemolytic uremic syndrome (n = 6), chronic antibody-mediated rejection (cAMR; n = 20), sensitization (n = 2), and immune thrombocytopenia (n = 1). The single-filtration TPE was performed in all cases. In 74.7% of patients, fresh frozen plasma was used as a replacement fluid. In 25.3% of patients, 4% albumin solution was used as a replacement fluid. Criteria for TPE efficacy included a decrease of proteinuria and normalization of renal function in NS; a normalization of platelet count, C3, and hemoglobin concentration in aHUS; improvement in renal function; and reduction of donor-specific antibodies in cAMR; and removal of antiplatelet antibodies in immune thrombocytopenia.Results
Efficacy results for patients with NS: 59.3% achieved remission, 25.9% achieved partial remission, and 14.8% achieved no remission, respectively. For patients with atypical hemolytic uremic syndrome there was remission in 66.6% and no remission in 33.4%. For patients with cAMR there was remission in 75% and no remission in 25%. Antiplatelet antibodies disappeared after TPE in 1 patient. In 9% of TPE procedures, minor complications were noted. All patients were on posttransplant maintenance immunosuppression and several children received additional treatment (intravenous immunoglobulin therapy or rituximab) during TPE therapy.Conclusion
TPE therapy (combined with immunosuppression) was an effective tool in most pediatric cases after renal transplantation with low incidence of minor adverse events. 相似文献6.
M. Jankowska I. Kuźmiuk-Glembin P. Skonieczny A. Dębska-Ślizień 《Transplantation proceedings》2018,50(6):1863-1867
Introduction
Patients with autosomal dominant polycystic kidney disease (ADPKD) represent about 10% of kidney transplant recipients (KTR) and have unique needs regarding acceptance for this procedure. Whether native kidney nephrectomy (NKN) affects kidney transplantation (KT) outcomes remains a matter of debate, and more data is needed to establish a standard approach to KTR with ADPKD.Aim
To analyze the prevalence, timing, and short- and long-term outcomes of NKN in a cohort of ADPKD recipients in a single institution.Method
Retrospective, observational study.Results
In the years 1993 to 2016 we identified 162 KTR with ADPKD; of those, 149 had known NKN status. A high proportion of ADPKD KTR (n = 72) underwent NKN, the majority of which (69.4%) were performed before KT. There was no difference in short-term and long-term transplantation outcomes (including death, graft loss, delayed graft function, acute rejection, bacterial and cytomegalovirus [CMV] infection, and post-transplant diabetes mellitus) between NKN and non-NKN groups in a median of 98 months of follow-up. However, we found a significant difference in time on a waiting list, which was longer in the NKN group vs non-NKN.Conclusions
There is a need for a consensus regarding indications and timing for NKN in recipients with ADPKD. The systematic acquisition, sharing, and analysis of accessible data on NKN between institutions is an important step toward meeting this need. In our cohort, we found no impact of the NKN procedure on KT impact. However, undergoing NKN significantly prolonged the time on the waiting list. 相似文献7.
Takeshi Morii Tomonori Kishino Naoko Shimamori Mitsue Motohashi Hiroaki Ohnishi Keita Honya Takayuki Aoyagi Takashi Tajima Shoichi Ichimura 《Journal of orthopaedic science》2018,23(2):403-407
Background
Preoperative evaluation of the risk of surgery-related blood loss in malignant soft tissue tumor resection is difficult because of wide variations in histological subtype, malignancy, location, and size. Ultrasonography is useful for the evaluation of blood flow around a soft tissue tumor and has the potential to preoperatively estimate intraoperative blood loss in tumor resection. To date, there has been no report regarding blood loss evaluation using ultrasonography in this field.Patients and Methods
The usefulness of information obtained by ultrasonography, including tumor size, vessel density in the tumor, and blood flow volume in the vessels, was analyzed for the prediction of intraoperative blood loss in malignant soft tissue tumor resection.Results
Vessel density in the tumor and blood flow in the vessels were identified as independent risk factors for blood loss. Using these factors, a new index for the prediction of blood loss was established. Receiver operating characteristic analyses revealed a high area under the curve value (0.80), confirming the accuracy of the index for the prediction of blood loss.Conclusion
Ultrasonography is a useful modality for predicting intraoperative blood loss in malignant soft tissue tumor surgery. 相似文献8.
M. Magott-Procelewska K. Madziarska M. Boratynska P. Chudoba A. Lepiesza O. Mazanowska S. Zmonarski M. Madziarski K. Hap M. Klinger 《Transplantation proceedings》2018,50(6):1701-1704
Background
The long-term burden of higher donor age on graft function and survival after kidney transplantation remains uncertain. Because both recipient and donor characteristics have evolved and the general population age is on the increase, we looked at the causes of kidney graft outcome.Aim
The aim of this study was to evaluate the impact of different clinical parameters on long-term outcome of older-donor kidney transplantation. This retrospective study included 345 adult patients (58 patients received kidney from donors at least 55 years old) transplanted between January 1993 and December 2005 and were followed in one center throughout the post-transplant course (median, 9.4 years). Data included recipient and donor age, cold ischemia time, delayed graft function, panel reactive antibodies, HLA mismatch, time on dialysis, graft function at different time points, uric acid level, proteinuria, immunosuppression, and biopsy-proven rejection.Results
Improvement of estimated glomerular filtration rate at 36 months after transplantation was a good prognostic factor for long-term kidney function. Higher donor age decreased the chance for improvement of kidney function by 2.8% per year of life (P = .0244). Hyperuricemia was found in 46% of the study population; estimated glomerular filtration rate less than 50 mL/min/1.72 m2 was associated with hyperuricaemia. A higher uric acid level was associated with inferior kidney function in recipient of older kidneys. Graft failure occurred late (median, 6.3 years post-transplantation) in 26 (44.8%) of older-donor recipients and in 87 (30.3%) of the remaining patients.Conclusions
Our results suggest an important association between older donor age and decreased allograft function in kidney recipients with elevated uric acid level. Recipients of older kidneys with normal uric acid level presented satisfactory outcomes. 相似文献9.
Background
Heart-lung transplantation is a well-established therapeutic modality for concomitant end-stage heart and lung failure. With growing organ scarcity, the rates of these transplants are declining, and center experience is waning.Methods
With over 35 years of experience performing heart-lung transplantation, we describe our procurement protocol herein, as well as offer suggestions to avoid potential pitfalls in order to ensure technical excellence in harvesting these valuable grafts.Results
Procurement issues most commonly arise with organ preservation and inadvertent damage to structures that are difficult to fully visualize.Conclusions
En-bloc heart-lung procurement can be taught effectively and safely to trainees with an emphasis on avoiding common pitfalls that may compromise graft function. 相似文献10.
K. Grąt M. Grąt O. Rowiński W. Patkowski K. Zieniewicz R. Pacho 《Transplantation proceedings》2018,50(7):2002-2005
Background
Despite worldwide debate on optimal selection of patients with hepatocellular carcinoma (HCC) for liver transplantation, the Milan criteria remain the benchmark for comparisons. Moreover, morphologic tumor features are universally considered important in pretransplant patient evaluation. The aim of this study was to establish the diagnostic accuracy of multiphasic computed tomography (CT) in assessing HCC burden before liver transplantation with special reference to Milan criteria fulfillment.Methods
This retrospective study was based on a data from 27 HCC patients after liver transplantation with available CT performed within 30 days pretransplant. CT results were compared with explant pathology with respect to Milan criteria fulfillment, tumor number, and diameter of the largest tumor.Results
Out of 19 patients within the Milan criteria on CT, 3 fell beyond the criteria on explant pathology with a gross underestimation rate of 15.8%. Out of 8 patients beyond the Milan criteria on CT, 3 were within the criteria on explant pathology with a gross overestimation rate of 37.5%. Regarding tumor number, CT was accurate only in 14 patients (51.9%), while overestimation and underestimation occurred in 5 (18.5%) and 8 (29.6%) patients, respectively. Overestimation and underestimation of largest tumor size by at least 1 cm occurred in 4 (14.8%) and 7 (25.9%) patients, respectively.Discussion
Multiphasic CT is associated with a remarkable risk of both under- and overestimation of HCC burden before transplantation. Transplant eligibility should not be solely based on CT results. 相似文献11.
Background
The selection of optimal donor is crucial for successful hematopoietic stem cell transplantation (HSCT). Thereby, it is appropriate to know, in addition to basic human leukocyte antigen (HLA) gene matches, other immunogenic or nonimmunogenic parameters predicting the outcome of transplant.Objective
A unified approach is necessary to provide a comprehensive view of the patient-donor compatibility characterization outside of standard HLA genes. The approach should be applicable as a tool for optimizing procedures for extended donor typing and/or verification typing of a donor.Methods
The study used the summary, unification, and innovation of existing practical knowledge and experience of the Czech National Marrow Donor Registry of various factors beyond HLA matching with impact on transplant outcome.Results
An information technology system–implemented procedure (a verification algorithm) is presented as the decision support approach for prematurely discarding less suitable donors from the transplantation process. It is intended primarily for the transplant specialist to help establish optimal procedures for verifying and determining donor critical factors.Conclusions
A process defining HLAs, killer cell immunoglobulin–like receptors, and cytokine typing strategies was proposed to provide support to a transplant specialist in refining the choice of a suitable donor. 相似文献12.
A. Sas P. Donizy K. Kościelska-Kasprzak D. Kamińska O. Mazanowska M. Krajewska P. Chudoba K. Korta A. Hałoń M. Klinger M. Banasik 《Transplantation proceedings》2018,50(6):1847-1849
The occurrence of anti-angiotensin II type 1 receptor (AT1R) antibodies is thought to be a risk factor for transplant injury, but the relationship of AT1R to graft loss in renal transplantation has not been assessed.The aim of our study was to evaluate the expression of AT1R and its relationship with graft loss in patients who had a renal transplant biopsy for cause.
Methods
AT1R immunoreactivity was analyzed in 170 renal transplant biopsies. Immunohistochemical evaluation of AT1R expression was performed on 4 μm-thick paraffin sections mounted on silanized slides. AT1R expression was analyzed in 5 compartments: 1. glomeruli, 2. renal blood vessels (small and intermediate arteries), 3. peritubular capillaries, 4. tubular epithelium, and 5. interstitium based on a 3-step scale.Results
Initially we checked 170 consecutive samples of biopsies for the immunoreactivity of the AT1R.The study finally included 118 renal transplant patients in 1-year observation after the biopsy. The renal allograft biopsy was performed between 6 days and 24 years after transplantation and the diagnosis was based on Banff criteria.We observed positive immunostaining of AT1R in tubular epithelium in 26.3% (42/118) of patients. A total of 7 patients had staining assessed as 2 and 35 as 1. One year post-biopsy graft loss in the AT1R (+) patients was 35.7 % (15/42) compared to 14.5% (11/76) in the AT1R (-) group (P = .008).Conclusions
The expression of AT1R in tubular epithelium of the biopsy for cause was associated with significantly higher graft loss. The relevance of AT1R should be considered for better transplant immunological risk assessment. 相似文献13.
G.S. Wu Q.C. Zhao Z.S. Li Y. Wu W.Z. Wang M.B. Li H. Shi M. Wang D.L. Chen J.Y. Zheng X. Wang D.M. Fan 《Transplantation proceedings》2017,49(1):232-236
Background
Antibody-mediated rejection (ABMR) has recently surfaced as a potential form of graft dysfunction after intestinal transplantation.Methods
We present a case of an intestinal transplant recipient who developed late-onset ABMR 12 years after living-donor transplantation. An 18-year-old male recipient with a history of extensive intestinal resection secondary to acute bowel volvulus exhibited an excellent baseline immune profile for transplantation, including ABO-identical and HLA-haploidentical to the donor; a negative cross-match with a panel reactive antibody of 3.0%.Results
Post-transplantation immunosuppression consisted of tacrolimus, mycophenolate mofetil (MMF), and prednisone within the first year, followed by tacrolimus and MMF in the second year, and maintenance with tacrolimus monotherapy thereafter. The recipient experienced a single episode of indetermined acute cellular rejection 3 months after transplantation. Since then, he did not require any parenteral nutrition and had completely reintegrated with society. Twelve years later, the patient developed persistent diarrhea associated with transplant biopsy diffuse C4d deposition and circulating donor-specific antibodies. After the use of rituximab and intravenous immunoglobulin, the recipient stabilized 17 years after transplantation with complete recovery of intestinal mucosal damage.Conclusion
Late-onset ABMR can emerge after transplantation and must be considered a possible cause of graft dysfunction in long-term intestinal transplantation survivors. 相似文献14.
Y. Kihara O. Konno T. Yokoyama Y. Nakamura T. Ueno H. Iwamoto 《Transplantation proceedings》2018,50(8):2531-2534
Introduction
The number of young women who wish to become pregnant opting for kidney transplants is increasing, as becoming pregnant under hemodialysis or peritoneal dialysis is associated with many risks. However, there have been reports indicating that these patients are subject to a higher risk of miscarriage compared to women with normal renal function. We examine and report cases of patients that experienced pregnancy after undergoing kidney transplantation at our hospital.Subjects and method
Of the kidney transplantation cases that were performed at our hospital between 1985 and 2016, there were 7 cases of pregnancy. The serum creatinine levels, urine protein findings, etc, of these 7 cases were examined during the pre-pregnancy, pregnancy, childbirth, and postpartum periods.Results
All 7 cases were able to give birth. There were two cases of transient postpartum hypertension. There were no cases of obvious pregnancy toxemia or fetal growth retardation. Two of the cases resulted in the failure of the transplanted kidneys.Discussion
According to previous studies on pregnancy and childbirth after kidney transplantation, the presence of high blood pressure and proteinuria as well as the renal function at the time of pregnancy is closely associated with postpartum renal function. Urine protein was detected prior to pregnancy in both cases and resulted in the failure of the transplanted kidneys. The influence of immunosuppressants on the mother and fetus is also an important consideration.Conclusion
We believe it is extremely important to ensure a thorough informed consent process prior to pregnancy and systematic use of immunosuppressants for young female transplant recipients. 相似文献15.
M. Myszka O. Mazanowska K. Kościelska-Kasprzak D. Bartoszek M. Żabińska M. Klinger 《Transplantation proceedings》2018,50(6):1802-1806
Background
Vitamin D and regulatory T cells (Tregs) are both involved in promoting peripheral tolerance and limiting chronic inflammatory diseases. Renal transplant recipients (RTRs) are likely to have low vitamin D levels, which may influence their immune status.Aim
The aim of our study was to assess the usefulness of serum 25-hydroxyvitamin D (25(OH)D) and Tregs in estimation of the protolerogenic milieu in RTRs within 1 year after kidney transplantation.Methods
26 RTRs (15M/11F, aged 49.1 ± 15.4 years) 3 to 13 months after kidney transplantation and 24 healthy volunteers were enrolled for the study. The serum level of 25(OH)D was measured with ELISA and peripheral blood immune cell populations (T lymphocytes, helper T lymphocytes, and Tregs) were assessed by flow cytometry.Results
Severe 25(OH)D deficiency (<10 ng/mL) was found in one RTR (3%) and moderate deficiency (<20 ng/mL) in 12 (46%), while vitamin D sufficiency was found in 6 patients (23%). The RTRs did not differ from the control group in observed 25(OH)D levels. None of the cell populations were related to the level of 25(OH)D in the control group. In RTRs, there was a negative association between 25(OH)D and total T lymphocyte count (rs = ?0.45, P = .023), but 25(OH)D was not related to any other cell population or kidney function.Conclusion
The results of our study suggest that serum 25(OH)D is not sufficiently reflective of vitamin D status to apply this measure in assessment of protolerogenic milieu in RTRs. 相似文献16.
17.
E. Karakulska-Prystupiuk G. Basak J. Dwilewicz-Trojaczek M. Paluszewska P. Boguradzki W. Jędrzejczak 《Transplantation proceedings》2018,50(7):2218-2222
Background
There are only a few cases of pericarditis complications following allogeneic bone marrow transplantation described in the literature and there are no data available on the risk and frequency of this condition. The aim of this study was to assess the frequency of exudative pericarditis complicating chronic graft-vs-host disease in allogeneic hematopoietic cell transplant recipients.Methods
Retrospective analysis involved a group of 105 patients of the Outpatient Transplantation Service of the Department of Hematology, Medical University of Warsaw, who received transplants in the years 2010–2016 and were evaluated for the years 2014–2016. In this group, 50 patients suffered from chronic graft-vs-host disease (cGVHD), including 24 with moderate or severe disease. Cardiology parameters evaluated included electrocardiography, echocardiography, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and systematic clinical follow-up.Results
Pericarditis was diagnosed in 6 patients (aged 20–56 years) within 4 to 23 months after allogenic hematopoietic stem cell transplantation. All patients suffered from severe cGVHD with involvement of at least 2 organs but none had earlier history of heart disease. All patients had elevated NT-proBNP and demonstrated signs of heart insufficiency grade II or III according to the New York Heart Association. There were no major changes in electrocardiogram. Only 1 patient improved following glucocorticosteroids as monotherapy, while others required complex approaches including tacrolimus plus sirolimus, rituximab, and extracorporeal photopheresis.Conclusion
Late pericarditis may occur in up to 5% of allogenic hematopoietic stem cell transplantation survivors, primarily affecting patients with moderate and severe grade cGVHD. It requires escalation of immunosuppressive treatment but usually has favorable outcome. Early diagnosis may be achieved by systematic NT-proBNP testing and periodic echocardiograph evaluation. 相似文献18.
Y. Okabe H. Noguchi K. Miyamoto K. Kaku A. Tsuchimoto K. Masutani M. Nakamura 《Transplantation proceedings》2018,50(10):3460-3466
Background
De novo complement-binding donor-specific anti-human leukocyte antigen antibodies (DSAs) are reportedly associated with an increased risk of kidney graft failure, but there is little information on preformed complement-binding DSAs. This study investigated the correlation between preformed C1q-binding DSAs and medium-term outcomes in kidney transplantation (KT).Methods
We retrospectively studied 44 pretransplant DSA-positive patients, including 36 patients who underwent KT between April 2010 and October 2016. There were 17 patients with C1q-binding DSAs and 27 patients without C1q-binding DSAs. Clinical variables were examined in the 2 groups.Results
Patients with C1q-binding DSAs had significantly higher blood transfusion history (53.0% vs 18.6%; P = .0174), complement-dependent cytotoxicity crossmatch (CDC-XM)-positivity (29.4% vs 0%; P = .0012), and DSA median fluorescence intensity (MFI) (10,974 vs 2764; P = .0009). Among patients who were not excluded for CDC-XM-positivity and underwent KT, there was no significant difference in cumulative biopsy-proven acute rejection rate (32.5% vs 33.5%; P = .8354), cumulative graft survival, and 3-month and 12-month protocol biopsy results between patients with and without C1q-binding DSAs. Although patients with C1q-binding DSAs showed a higher incidence of delayed graft function (54.6% vs 20.0%; P = .0419), multivariate logistic regression showed that DSA MFI (P = .0124), but not C1q-binding DSAs (P = .2377), was an independent risk factor for delayed graft function.Conclusions
In patients with CDC-XM-negativity, preformed C1q-binding DSAs were not associated with incidence of antibody-mediated rejection and medium-term graft survival after KT. C1q-binding DSAs were highly correlated with DSA MFI and CDC-XM-positivity. 相似文献19.
Y. Zhao Y. Wang M.S. Zhu W.M. Han Z. Li S.F. Hong P. Yin G.H. Zhuang Z.Q. Qi 《Transplantation proceedings》2018,50(1):293-298
Background
Tumor necrosis factor-α–induced protein-8 like-2 (TIPE2) is a negative regulator of innate immunity and cellular immunity, yet the expression pattern of TIPE2 in acute rejection of cardiac allograft remain enigmatic.Methods
We developed cardiac transplantation models and divided into 3 groups: a naive group, a syngeneic group, and an allogeneic group. Then, we detected the messenger RNA and protein of TIPE2 in cardiac allografts. Real-time polymerase chain reaction showed expression of CD4 and CD8 in the donor heart, and immunofluorescence assay revealed the association between T cells and TIPE2.Results
In our study, we first found that the expression of TIPE2 in cardiac allografts is upregulated compared with the syngeneic control, and increases in a time-dependent manner. The immunocytochemistry of heart grafts revealed a strong expression of TIPE2 in the inflammatory cells, but not in the cardiomyocytes. Finally, we proved that CD4+ and CD8+ T cells infiltrated cardiac allografts abundantly, which express ample TIPE2.Conclusions
The upregulated expression of TIPE2 in cardiac allografts, mainly came from T cells, which infiltrated the donor heart. This finding indicates that there may be an association between TIPE2 and acute cardiac allograft rejection. 相似文献20.
T.-H. Shih Y.-H. Tsou C.-J. Huang C.-L. Chen K.-W. Cheng S.-C. Wu S.-C. Yang S.-E. Juang C.-E. Huang Y.-E. Lee B. Jawan C.-H. Wang K.-A. Chang 《Transplantation proceedings》2018,50(9):2661-2663