PMID- 17456201
OWN - NLM
STAT- MEDLINE
DCOM- 20070807
LR  - 20230124
IS  - 1600-6135 (Print)
IS  - 1600-6135 (Linking)
VI  - 7
IP  - 5
DP  - 2007 May
TI  - Pretransplant HLA antibodies are associated with reduced graft survival after 
      clinical islet transplantation.
PG  - 1242-8
AB  - Despite significant improvements in islet transplantation, long-term graft 
      function is still not optimal. It is likely that both immune and nonimmune 
      factors are involved in the deterioration of islet function over time. 
      Historically, the pretransplant T-cell crossmatch and antibody screening were 
      done by anti-human globulin--complement-dependent cytotoxicity (AHG-CDC). Class 
      II antibodies were not evaluated. In 2003, we introduced solid-phase antibody 
      screening using flow-based beads and flow crossmatching. We were interested to 
      know whether pretransplant human leukocyte antigen (HLA) antibodies or a positive 
      flow crossmatch impacted islet function post-transplant. A total of 152 islet 
      transplants was performed in 81 patients. Islet function was determined by a 
      positive C-peptide. Results were analyzed by procedure. Class I and class II 
      panel reactive antibody (PRA) > 15% and donor-specific antibodies (DSA) were 
      associated with a reduced C-peptide survival (p<0.0001 and p<0.0001, 
      respectively). A positive T- and or B-cell crossmatch alone was not. 
      Pretransplant HLA antibodies detectable by flow beads are associated with reduced 
      graft survival. This suggests that the sirolimus and low-dose tacrolimus-based 
      immunosuppression may not control the alloimmune response in this presensitized 
      population and individuals with a PRA > 15% may require more aggressive inductive 
      and maintenance immunosuppression, or represent a group that may not benefit from 
      islet transplantation.
FAU - Campbell, P M
AU  - Campbell PM
AD  - Department of Medicine, Division of Nephrology and Immunology, University of 
      Alberta, Capital Health, Edmonton, Alberta, Canada. trish.campbell@ualberta.ca
FAU - Salam, A
AU  - Salam A
FAU - Ryan, E A
AU  - Ryan EA
FAU - Senior, P
AU  - Senior P
FAU - Paty, B W
AU  - Paty BW
FAU - Bigam, D
AU  - Bigam D
FAU - McCready, T
AU  - McCready T
FAU - Halpin, A
AU  - Halpin A
FAU - Imes, S
AU  - Imes S
FAU - Al Saif, F
AU  - Al Saif F
FAU - Lakey, J R T
AU  - Lakey JR
FAU - Shapiro, A M J
AU  - Shapiro AM
LA  - eng
GR  - DK59101/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am J Transplant
JT  - American journal of transplantation : official journal of the American Society of 
      Transplantation and the American Society of Transplant Surgeons
JID - 100968638
RN  - 0 (Antibodies)
RN  - 0 (Antilymphocyte Serum)
RN  - 0 (C-Peptide)
RN  - 0 (Histocompatibility Antigens Class I)
RN  - 0 (Histocompatibility Antigens Class II)
RN  - 0 (Immunosuppressive Agents)
RN  - W36ZG6FT64 (Sirolimus)
RN  - WM0HAQ4WNM (Tacrolimus)
SB  - IM
MH  - Adult
MH  - Antibodies/*immunology
MH  - Antilymphocyte Serum/therapeutic use
MH  - B-Lymphocytes/immunology/pathology
MH  - C-Peptide/metabolism
MH  - Female
MH  - Graft Rejection/prevention & control
MH  - Graft Survival/*immunology
MH  - Histocompatibility Antigens Class I/*immunology
MH  - Histocompatibility Antigens Class II/*immunology
MH  - Histocompatibility Testing
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Islets of Langerhans/immunology/metabolism
MH  - Islets of Langerhans Transplantation/*immunology/pathology
MH  - Male
MH  - Proportional Hazards Models
MH  - Sirolimus/therapeutic use
MH  - T-Lymphocytes/immunology/pathology
MH  - Tacrolimus/therapeutic use
MH  - Treatment Outcome
EDAT- 2007/04/26 09:00
MHDA- 2007/08/08 09:00
CRDT- 2007/04/26 09:00
PHST- 2007/04/26 09:00 [pubmed]
PHST- 2007/08/08 09:00 [medline]
PHST- 2007/04/26 09:00 [entrez]
AID - S1600-6135(22)02732-0 [pii]
AID - 10.1111/j.1600-6143.2007.01777.x [doi]
PST - ppublish
SO  - Am J Transplant. 2007 May;7(5):1242-8. doi: 10.1111/j.1600-6143.2007.01777.x.