PMID- 17984841
OWN - NLM
STAT- MEDLINE
DCOM- 20071130
LR  - 20071106
IS  - 0041-1337 (Print)
IS  - 0041-1337 (Linking)
VI  - 84
IP  - 7
DP  - 2007 Oct 15
TI  - Blood levels of donor-specific human leukocyte antigen antibodies after renal 
      transplantation: resolution of rejection in the presence of circulating 
      donor-specific antibody.
PG  - 876-84
AB  - BACKGROUND: Accommodation to antibody is an important mechanism in successful 
      ABO-incompatible transplantation, but its importance in human leukocyte antigen 
      (HLA) antibody-incompatible transplantation is less clear, as sensitive 
      techniques facilitating daily measurement of donor-specific HLA antibodies (DSAs) 
      have only recently been developed. METHODS: We report 24 patients who had HLA 
      antibody-incompatible kidney transplantation (21 living donors, 3 deceased), 21 
      of whom had pretransplant plasmapheresis. Eight had positive complement-dependent 
      cytotoxic (CDC) crossmatch (XM) pretransplant plasmapheresis, nine had positive 
      flow cytometric (FC) XM, and seven had DSA detectable by microbead analysis only. 
      After transplant, DSA levels were monitored closely with microbead assays. 
      RESULTS: Rejection occurred in five of eight (62.5%) CDC-positive cases, in three 
      of nine (33%) FC-positive cases, and in two of seven (29%) of microbead-only 
      cases at a median of 6.5 days after transplantation. Resolution occurred at a 
      median of 15 days after transplantation, in 8 of 10 cases when the microbead 
      level of DSA had median fluorescence intensity (MFI) >2000 U, in 6 of 10 when the 
      microbead MFI >4000 U. In 8 of 10 cases, the microbead MFI at the time of 
      resolution was greater than at the onset. DSA did not always cause clinical 
      rejection. In five cases with a posttransplant DSA peaking at MFI >2000 U on 
      microbead assay, rejection did not occur. CONCLUSION: These data suggest that the 
      dominant method of successful transplantation was function of the transplant in 
      the presence of circulating DSA, and they also define the period during which 
      this occurred.
FAU - Higgins, Rob
AU  - Higgins R
AD  - Transplant Unit, University Hospitals Coventry and Warwickshire, Coventry, West 
      Midlands, UK. Robert.Higgins@uhcw.nhs.uk
FAU - Hathaway, Mark
AU  - Hathaway M
FAU - Lowe, David
AU  - Lowe D
FAU - Lam, For
AU  - Lam F
FAU - Kashi, Habib
AU  - Kashi H
FAU - Tan, Lam Chin
AU  - Tan LC
FAU - Imray, Chris
AU  - Imray C
FAU - Fletcher, Simon
AU  - Fletcher S
FAU - Zehnder, Daniel
AU  - Zehnder D
FAU - Chen, Klaus
AU  - Chen K
FAU - Krishnan, Nithya
AU  - Krishnan N
FAU - Hamer, Rizwan
AU  - Hamer R
FAU - Briggs, David
AU  - Briggs D
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (Antibodies)
RN  - 0 (HLA Antigens)
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Polystyrenes)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Antibodies/chemistry
MH  - Biopsy
MH  - Flow Cytometry
MH  - Graft Survival
MH  - HLA Antigens/chemistry/*immunology
MH  - *Histocompatibility Testing
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Kidney Transplantation/*immunology/methods
MH  - Living Donors
MH  - Middle Aged
MH  - Plasmapheresis
MH  - Polystyrenes/chemistry
MH  - Time Factors
EDAT- 2007/11/07 09:00
MHDA- 2007/12/06 09:00
CRDT- 2007/11/07 09:00
PHST- 2007/11/07 09:00 [pubmed]
PHST- 2007/12/06 09:00 [medline]
PHST- 2007/11/07 09:00 [entrez]
AID - 00007890-200710150-00012 [pii]
AID - 10.1097/01.tp.0000284729.39137.6e [doi]
PST - ppublish
SO  - Transplantation. 2007 Oct 15;84(7):876-84. doi: 
      10.1097/01.tp.0000284729.39137.6e.