PMID- 20075791
OWN - NLM
STAT- MEDLINE
DCOM- 20100429
LR  - 20220408
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 89
IP  - 8
DP  - 2010 Apr 27
TI  - Beyond histology: lowering human leukocyte antigen antibody to improve renal 
      allograft survival in acute rejection.
PG  - 962-7
LID - 10.1097/TP.0b013e3181cbac02 [doi]
AB  - BACKGROUND: The common endpoint in the treatment of antibody-mediated rejection 
      (AMR) is functional reversal (creatinine levels). Reduction of human leukocyte 
      antigen (HLA) antibody strength is not commonly considered as an essential 
      endpoint for AMR resolution. The purpose of this study was to determine whether 
      reduction in HLA antibody intensity in patients with histologic AMR reversal 
      influences long-term renal allograft survival. METHODS: Renal allograft 
      recipients were included if he or she had a biopsy diagnosis of AMR (between 
      August 2000 and October 2008) and serial evaluation for HLA antibodies prebiopsy 
      and postbiopsy. Antibody reduction was defined as mean fluorescence intensity 
      decrease more than 50% in highest intensity antibody after AMR therapy and the 
      absence of new antibody formation. Patients were treated with plasmapheresis, 
      thymoglobulin/OKT3, and corticosteroids. Survival analysis was performed using 
      STATA/MP v10 (College Station, TX). RESULTS: Twenty-eight patients were analyzed. 
      Antibody reduction failed to occur in 22 of 28 cases. Baseline characteristics 
      were similar between groups. Antibody nonresponders had significantly shorter 
      allograft survival time (61.4 months) compared with antibody responders (no 
      failures) (P=0.04, log-rank test). CONCLUSIONS: In conclusion, failure to 
      significantly reduce antibody levels and prevent new formation was strongly 
      predictive of allograft loss. This observation suggests that the therapeutic 
      intervention that reduces antibody production may prolong graft survival in 
      transplantation.
FAU - Everly, Matthew J
AU  - Everly MJ
AD  - Terasaki Foundation Laboratory, Los Angeles, CA 90064, USA. 
      meverly@terasakilab.org
FAU - Rebellato, Lorita M
AU  - Rebellato LM
FAU - Ozawa, Mikki
AU  - Ozawa M
FAU - Briley, Kimberly P
AU  - Briley KP
FAU - Catrou, Paul G
AU  - Catrou PG
FAU - Haisch, Carl E
AU  - Haisch CE
FAU - Terasaki, Paul I
AU  - Terasaki PI
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Antilymphocyte Serum)
RN  - 0 (HLA Antigens)
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Isoantibodies)
RN  - 0 (Muromonab-CD3)
RN  - D7RD81HE4W (thymoglobulin)
SB  - IM
EIN - Transplantation. 2010 Jul 15;90(1):103
MH  - Acute Disease
MH  - Adrenal Cortex Hormones/therapeutic use
MH  - Adult
MH  - Antibodies, Monoclonal/therapeutic use
MH  - Antibody Formation
MH  - Antilymphocyte Serum
MH  - Biopsy
MH  - Down-Regulation
MH  - Drug Therapy, Combination
MH  - Female
MH  - Graft Rejection/immunology/pathology/*prevention & control
MH  - *Graft Survival
MH  - HLA Antigens/*immunology
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Isoantibodies/biosynthesis/*blood
MH  - Kaplan-Meier Estimate
MH  - Kidney Transplantation/*immunology
MH  - Male
MH  - Middle Aged
MH  - Muromonab-CD3/therapeutic use
MH  - Plasmapheresis
MH  - Retrospective Studies
MH  - Time Factors
MH  - Transplantation, Homologous
MH  - Treatment Outcome
EDAT- 2010/01/16 06:00
MHDA- 2010/04/30 06:00
CRDT- 2010/01/16 06:00
PHST- 2010/01/16 06:00 [entrez]
PHST- 2010/01/16 06:00 [pubmed]
PHST- 2010/04/30 06:00 [medline]
AID - 10.1097/TP.0b013e3181cbac02 [doi]
PST - ppublish
SO  - Transplantation. 2010 Apr 27;89(8):962-7. doi: 10.1097/TP.0b013e3181cbac02.