PMID- 18301338
OWN - NLM
STAT- MEDLINE
DCOM- 20080328
LR  - 20131121
IS  - 0041-1337 (Print)
IS  - 0041-1337 (Linking)
VI  - 85
IP  - 3
DP  - 2008 Feb 15
TI  - Pretransplant donor-specific and non-specific immune parameters associated with 
      early acute rejection.
PG  - 462-70
LID - 10.1097/TP.0b013e3181612ead [doi]
AB  - BACKGROUND: New immunosuppression protocols have resulted in decreased rates of 
      biopsy-proven acute rejection; however, it is unclear whether recipients without 
      biopsy-proven acute rejection are still at risk for immune complication and 
      chronic allograft dysfunction. The aim of our studies was to determine whether 
      pretransplant immune parameters were associated with posttransplant early acute 
      rejection, unstable creatinine courses, and poor graft outcome. METHODS: Immune 
      parameters, including human leukocyte antigen (HLA) mismatch, HLA-specific 
      antibodies, global CD4+ cellular response as measured by intracellular adenosine 
      triphosphate (iATP) synthesis, and IFN-gamma precursor frequencies to donor or 
      third-party cells as measured by ELISPOT were determined for a total of 126 
      kidney recipients treated with a protocol, including rapid discontinuation of 
      prednisone. RESULTS: The donor specific pretransplant parameters of HLA class I 
      mismatches (P=0.04) and total HLA mismatches (P=0.04) with the donor as well as 
      the pretransplant HLA-donor specific antibodies (P=0.002) were associated with 
      biopsy-proven acute rejection. Higher pretransplant iATP levels, a donor 
      nonspecific parameter, were found associated with biopsy proven acute rejection 
      (P=0.04). Pretransplant iATP levels were significantly greater for recipients 
      with early unstable creatinine levels (P=0.01). Recipients with a pretransplant 
      iATP value greater than 375 ng/ml were 3.67 times more likely to experience acute 
      rejection (P=0.03). CONCLUSIONS: Pretransplant assessment of donor specific and 
      nonspecific immune parameters may identify recipients who can benefit from closer 
      clinical and immunological surveillance to allow for tailored immunsuppression 
      and selective intervention aimed at optimizing both short and long-term graft 
      outcome.
FAU - Reinsmoen, Nancy L
AU  - Reinsmoen NL
AD  - David Geffen School of Medicine at UCLA,Cedars-Sinai Medical Center, Los Angeles, 
      CA 90048, USA. nancy.reinsmoen@cshs.org
FAU - Cornett, Karen M M
AU  - Cornett KM
FAU - Kloehn, Robert
AU  - Kloehn R
FAU - Burnette, Angela D
AU  - Burnette AD
FAU - McHugh, Lois
AU  - McHugh L
FAU - Flewellen, Barbara K
AU  - Flewellen BK
FAU - Matas, Arthur
AU  - Matas A
FAU - Savik, Kay
AU  - Savik K
LA  - eng
GR  - DK64588-03/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (Antibodies)
RN  - 0 (HLA Antigens)
RN  - 82115-62-6 (Interferon-gamma)
RN  - MU72812GK0 (Creatine)
SB  - IM
MH  - Acute Disease
MH  - Antibodies/immunology
MH  - Biopsy
MH  - Clinical Trials as Topic
MH  - Creatine/blood
MH  - Female
MH  - Graft Rejection/*immunology
MH  - HLA Antigens/immunology
MH  - Humans
MH  - Interferon-gamma/biosynthesis/immunology
MH  - Kidney Transplantation/*immunology
MH  - Male
MH  - Middle Aged
MH  - Models, Immunological
MH  - Risk Factors
MH  - Sensitivity and Specificity
MH  - *Tissue Donors
MH  - Treatment Outcome
EDAT- 2008/02/28 09:00
MHDA- 2008/03/29 09:00
CRDT- 2008/02/28 09:00
PHST- 2008/02/28 09:00 [pubmed]
PHST- 2008/03/29 09:00 [medline]
PHST- 2008/02/28 09:00 [entrez]
AID - 00007890-200802150-00016 [pii]
AID - 10.1097/TP.0b013e3181612ead [doi]
PST - ppublish
SO  - Transplantation. 2008 Feb 15;85(3):462-70. doi: 10.1097/TP.0b013e3181612ead.