PMID- 26840927
OWN - NLM
STAT- MEDLINE
DCOM- 20161110
LR  - 20171116
IS  - 2059-2310 (Electronic)
IS  - 2059-2302 (Linking)
VI  - 87
IP  - 2
DP  - 2016 Feb
TI  - Pre-transplant soluble CD30 in combination with total DSA but not pre-transplant 
      C1q-DSA predicts antibody-mediated graft loss in presensitized high-risk kidney 
      transplant recipients.
PG  - 89-99
LID - 10.1111/tan.12735 [doi]
AB  - Presensitized kidney transplant recipients are at high-risk for early 
      antibody-mediated rejection. We studied the impact of pre- and post-transplant 
      donor-specific human leukocyte antigen (HLA) antibodies (DSA) and 
      T-cell-activation on the occurrence of antibody-mediated rejection episodes (AMR) 
      and graft loss (AMR-GL) in a unique cohort of 80 desensitized high-risk kidney 
      transplant recipients. Patients with pre-transplant DSA demonstrated more AMR 
      episodes than patients without DSA, but did not show a significantly increased 
      rate of AMR-GL. The rates of AMR and AMR-GL were not significantly increased in 
      patients with complement split product (C1q)-binding pre-transplant DSA. 
      Pre-transplant C1q-DSA became undetectable post-transplant in 11 of 13 (85%) 
      patients; 2 (18%) of these 11 patients showed AMR but no AMR-GL. In contrast, the 
      post-transplant presence of C1q-DSA was associated with significantly higher 
      rates of AMR (86 vs 33 vs 0%; P < 0.001) and AMR-GL (86 vs 0 vs 0%; log-rank P < 
      0.001) compared with post-transplant DSA without C1q-binding or the absence of 
      DSA. Patients with both pre-transplant DSA and evidence of pre-transplant 
      T-cell-activation as indicated by soluble CD30-positivity showed a significantly 
      increased risk for AMR-GL [HR = 11.1, 95% confidence interval (CI) = 1.68-73.4; 
      log-rank P = 0.013]. In these high-risk patients, AMR-GL was associated with 
      total DSA in combination with T-cell-activation pre-transplant, and de novo or 
      persistent C1q-binding DSA post-transplant.
CI  - (c) 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
FAU - Schaefer, S M
AU  - Schaefer SM
AD  - Division of Nephrology, University Hospital of Heidelberg, Heidelberg, Germany.
FAU - Susal, C
AU  - Susal C
AD  - Transplantation Immunology, Institute of Immunology, University of Heidelberg, 
      Heidelberg, Germany.
FAU - Opelz, G
AU  - Opelz G
AD  - Transplantation Immunology, Institute of Immunology, University of Heidelberg, 
      Heidelberg, Germany.
FAU - Dohler, B
AU  - Dohler B
AD  - Transplantation Immunology, Institute of Immunology, University of Heidelberg, 
      Heidelberg, Germany.
FAU - Becker, L E
AU  - Becker LE
AD  - Division of Nephrology, University Hospital of Heidelberg, Heidelberg, Germany.
FAU - Klein, K
AU  - Klein K
AD  - Division of Nephrology, University Hospital of Heidelberg, Heidelberg, Germany.
FAU - Sickmuller, S
AU  - Sickmuller S
AD  - Division of Nephrology, University Hospital of Heidelberg, Heidelberg, Germany.
FAU - Waldherr, R
AU  - Waldherr R
AD  - Department of Pathology, University of Heidelberg, Heidelberg, Germany.
FAU - Macher-Goeppinger, S
AU  - Macher-Goeppinger S
AD  - Department of Pathology, University of Heidelberg, Heidelberg, Germany.
FAU - Schemmer, P
AU  - Schemmer P
AD  - Division of Transplantation Surgery, University of Heidelberg, Heidelberg, 
      Germany.
FAU - Beimler, J
AU  - Beimler J
AD  - Division of Nephrology, University Hospital of Heidelberg, Heidelberg, Germany.
FAU - Zeier, M
AU  - Zeier M
AD  - Division of Nephrology, University Hospital of Heidelberg, Heidelberg, Germany.
FAU - Morath, C
AU  - Morath C
AD  - Division of Nephrology, University Hospital of Heidelberg, Heidelberg, Germany.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20160203
PL  - England
TA  - HLA
JT  - HLA
JID - 101675570
RN  - 0 (Complement C1)
RN  - 0 (Isoantibodies)
RN  - 0 (Ki-1 Antigen)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Complement C1/immunology/metabolism
MH  - Female
MH  - Graft Rejection/*blood/immunology
MH  - Humans
MH  - Isoantibodies/*blood/immunology
MH  - Ki-1 Antigen/*blood/immunology
MH  - *Kidney Transplantation
MH  - *Lymphocyte Activation
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - *Preoperative Period
MH  - T-Lymphocytes/immunology/*metabolism
OTO - NOTNLM
OT  - B-cell
OT  - C1q
OT  - antibody-mediated rejection
OT  - donor-specific antibodies
OT  - human leukocyte antigen
OT  - increased soluble CD30
OT  - kidney
OT  - rejection
OT  - transplantation
EDAT- 2016/02/04 06:00
MHDA- 2016/11/12 06:00
CRDT- 2016/02/04 06:00
PHST- 2015/05/13 00:00 [received]
PHST- 2015/12/11 00:00 [revised]
PHST- 2016/01/04 00:00 [accepted]
PHST- 2016/02/04 06:00 [entrez]
PHST- 2016/02/04 06:00 [pubmed]
PHST- 2016/11/12 06:00 [medline]
AID - 10.1111/tan.12735 [doi]
PST - ppublish
SO  - HLA. 2016 Feb;87(2):89-99. doi: 10.1111/tan.12735. Epub 2016 Feb 3.