PMID- 28348361
OWN - NLM
STAT- MEDLINE
DCOM- 20170926
LR  - 20190609
IS  - 2329-0358 (Electronic)
IS  - 1425-9524 (Linking)
VI  - 22
DP  - 2017 Mar 28
TI  - The Impact of Donor-Specific Anti-Human Leukocyte Antigen (HLA) Antibody Rebound 
      on the Risk of Antibody Mediated Rejection in Sensitized Kidney Transplant 
      Recipients.
PG  - 166-176
AB  - BACKGROUND Donor-specific anti-HLA antibody (DSA) detected on Luminex-based 
      single antigen assay (LSA) has become the subject of desensitization based upon 
      the results of previous studies. We retrospectively investigated the impact of 
      preoperative DSA on the incidence of antibody mediated rejection (AMR) in 
      patients desensitized using a protocol based on rituximab and rabbit 
      antithymocyte globulin (rATG). MATERIAL AND METHODS Nine patients (Group 1, 
      9/327, 2.8%) were complement dependent cytotoxicity crossmatch (CDC-XM) positive 
      and underwent desensitization with rituximab (375 mg/m(2)), intravenous 
      immunoglobulin (IVIG; 400 mg/kg), plasmapheresis, and rATG. Twenty-two patients 
      (Group 2, 22/327, 6.7%) were CDC-XM negative but DSA positive on LSA and had 
      received desensitization with rituximab and rATG, while 55 patients (Group 3, 
      55/327, 16.8%) were CDC-XM and DSA negative with a calculated panel reactive 
      antibody (cPRA) >/=50%. Another 241 patients (Group 4, 241/327, 73.7%) were CDC-XM 
      and DSA negative with a cPRA <50%. RESULTS Recipients with DSA (Group 2) 
      experienced more AMR than other groups (p<0.01). More de novo DSAs also developed 
      in Group 2 (p<0.001). The mean fluorescence intensity (MFI) of DSA of patients 
      with AMR tended to rebound (p=0.01). CONCLUSIONS Patients who were CDC-XM 
      negative but DSA positive status were at a higher risk of developing AMR even 
      though they had received desensitization with rATG and rituximab. A more intense 
      desensitization protocol is needed for these recipients. Patients with MFI 
      rebound of DSA should be carefully monitored for the risk of AMR.
FAU - Lee, Kyo Won
AU  - Lee KW
AD  - Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of 
      Medicine, Seoul, South Korea.
FAU - Park, Jae Berm
AU  - Park JB
AD  - Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of 
      Medicine, Seoul, South Korea.
FAU - Cho, Chan Woo
AU  - Cho CW
AD  - Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of 
      Medicine, Seoul, South Korea.
FAU - Lee, Nuri
AU  - Lee N
AD  - Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of 
      Medicine, Seoul, South Korea.
FAU - Yoo, Heejin
AU  - Yoo H
AD  - Biostatistics and Clinical Epidemiology Center, Research Institute for Future 
      Medicine, Samsung Medical Center, Seoul, South Korea.
FAU - Kim, Kyunga
AU  - Kim K
AD  - Biostatistics and Clinical Epidemiology Center, Research Institute for Future 
      Medicine, Samsung Medical Center, Seoul, South Korea.
FAU - Park, Hyojun
AU  - Park H
AD  - Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of 
      Medicine, Seoul, South Korea.
FAU - Kang, Eun Suk
AU  - Kang ES
AD  - Department of Laboratory Medicine and Genetics, Samsung Medical Center, 
      Sungkyunkwan University School of Medicine, Seoul, South Korea.
FAU - Huh, Wooseong
AU  - Huh W
AD  - Division of Nephrology, Department of Medicine, Samsung Medical Center, 
      Sungkyunkwan University School of Medicine, Seoul, South Korea.
FAU - Kim, Sungjoo
AU  - Kim S
AD  - Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of 
      Medicine, Seoul, South Korea.
LA  - eng
PT  - Journal Article
DEP - 20170328
PL  - United States
TA  - Ann Transplant
JT  - Annals of transplantation
JID - 9802544
RN  - 0 (Antilymphocyte Serum)
RN  - 0 (HLA Antigens)
RN  - 4F4X42SYQ6 (Rituximab)
SB  - IM
MH  - Adult
MH  - Antilymphocyte Serum/therapeutic use
MH  - Female
MH  - Graft Rejection/*immunology
MH  - HLA Antigens/*immunology
MH  - Histocompatibility Testing
MH  - Humans
MH  - Kidney Failure, Chronic/immunology/*surgery
MH  - Kidney Transplantation/*methods
MH  - Male
MH  - Middle Aged
MH  - Plasmapheresis
MH  - Retrospective Studies
MH  - Rituximab/therapeutic use
MH  - *Transplant Recipients
MH  - Young Adult
EDAT- 2017/03/30 06:00
MHDA- 2017/09/28 06:00
CRDT- 2017/03/29 06:00
PHST- 2017/03/29 06:00 [entrez]
PHST- 2017/03/30 06:00 [pubmed]
PHST- 2017/09/28 06:00 [medline]
AID - 902266 [pii]
AID - 10.12659/aot.902266 [doi]
PST - epublish
SO  - Ann Transplant. 2017 Mar 28;22:166-176. doi: 10.12659/aot.902266.