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Al-Awadhi S, Raynaud M, Louis K, Bouquegneau A, Taupin JL, Aubert O, Loupy A, Lefaucheur C. Complement-activating donor-specific anti-HLA antibodies in solid organ transplantation: systematic review, meta-analysis, and critical appraisal. Front Immunol 2023; 14:1265796. [PMID: 37849755 PMCID: PMC10577173 DOI: 10.3389/fimmu.2023.1265796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/07/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction Several studies have investigated the impact of circulating complement-activating anti-human leukocyte antigen donor-specific antibodies (anti-HLA DSAs) on organ transplant outcomes. However, a critical appraisal of these studies and a demonstration of the prognostic value of complement-activating status over anti-HLA DSA mean fluorescence intensity (MFI) level are lacking. Methods We conducted a systematic review, meta-analysis and critical appraisal evaluating the role of complement-activating anti-HLA DSAs on allograft outcomes in different solid organ transplants. We included studies through Medline, Cochrane, Scopus, and Embase since inception of databases till May 05, 2023. We evaluated allograft loss as the primary outcome, and allograft rejection as the secondary outcome. We used the Newcastle-Ottawa Scale and funnel plots to assess risk of bias and used bias adjustment methods when appropriate. We performed multiple subgroup analyses to account for sources of heterogeneity and studied the added value of complement assays over anti-HLA DSA MFI level. Results In total, 52 studies were included in the final meta-analysis (11,035 patients). Complement-activating anti-HLA DSAs were associated with an increased risk of allograft loss (HR 2.77; 95% CI 2.33-3.29, p<0.001; I²=46.2%), and allograft rejection (HR 4.98; 95% CI 2.96-8.36, p<0.01; I²=70.9%). These results remained significant after adjustment for potential sources of bias and across multiple subgroup analyses. After adjusting on pan-IgG anti-HLA DSA defined by the MFI levels, complement-activating anti-HLA DSAs were significantly and independently associated with an increased risk of allograft loss. Discussion We demonstrated in this systematic review, meta-analysis and critical appraisal the significant deleterious impact and the independent prognostic value of circulating complement-activating anti-HLA DSAs on solid organ transplant risk of allograft loss and rejection.
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Affiliation(s)
- Solaf Al-Awadhi
- Université de Paris Cité, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR)-S970, Paris Cardiovascular Research Center (PARCC), Paris Translational Research Centre for Organ Transplantation, Paris, France
| | - Marc Raynaud
- Université de Paris Cité, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR)-S970, Paris Cardiovascular Research Center (PARCC), Paris Translational Research Centre for Organ Transplantation, Paris, France
| | - Kevin Louis
- Université de Paris Cité, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR)-S970, Paris Cardiovascular Research Center (PARCC), Paris Translational Research Centre for Organ Transplantation, Paris, France
- Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Antoine Bouquegneau
- Université de Paris Cité, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR)-S970, Paris Cardiovascular Research Center (PARCC), Paris Translational Research Centre for Organ Transplantation, Paris, France
- Department of Nephrology, Dialysis and Transplantation, Centre Hospitalier Universitaire (CHU) de Liège, Liège, Belgium
| | - Jean-Luc Taupin
- Department of Immunology and Histocompatibility, Centre Hospitalier Universitaire (CHU) Paris–GH St–Louis Lariboisière, Paris, France
| | - Olivier Aubert
- Université de Paris Cité, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR)-S970, Paris Cardiovascular Research Center (PARCC), Paris Translational Research Centre for Organ Transplantation, Paris, France
- Kidney Transplant Department, Necker Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Alexandre Loupy
- Université de Paris Cité, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR)-S970, Paris Cardiovascular Research Center (PARCC), Paris Translational Research Centre for Organ Transplantation, Paris, France
- Kidney Transplant Department, Necker Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Carmen Lefaucheur
- Université de Paris Cité, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR)-S970, Paris Cardiovascular Research Center (PARCC), Paris Translational Research Centre for Organ Transplantation, Paris, France
- Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
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Khedraki R, Noguchi H, Baldwin WM. Balancing the View of C1q in Transplantation: Consideration of the Beneficial and Detrimental Aspects. Front Immunol 2022; 13:873479. [PMID: 35401517 PMCID: PMC8988182 DOI: 10.3389/fimmu.2022.873479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Raneem Khedraki
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Biological, Geological, and Environmental Sciences, Cleveland State University, Cleveland, OH, United States
| | - Hirotsugu Noguchi
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - William M. Baldwin
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Biological, Geological, and Environmental Sciences, Cleveland State University, Cleveland, OH, United States
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Ziemann M, Suwelack B, Banas B, Budde K, Einecke G, Hauser I, Heinemann FM, Kauke T, Kelsch R, Koch M, Lachmann N, Reuter S, Seidl C, Sester U, Zecher D. Determination of unacceptable HLA antigen mismatches in kidney transplant recipients. HLA 2021; 100:3-17. [PMID: 34951119 DOI: 10.1111/tan.14521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/27/2022]
Abstract
With the introduction of the virtual allocation crossmatch in the Eurotransplant (ET) region in 2023, the determination of unacceptable antigen mismatches (UAM) in kidney transplant recipients is of utmost importance for histocompatibility laboratories and transplant centers. Therefore, a joined working group of members from the German Society for Immunogenetics (Deutsche Gesellschaft für Immungenetik, DGI) and the German Transplantation Society (Deutsche Transplantationsgesellschaft, DTG) revised and updated the previous recommendations from 2015 in light of recently published evidence. Like in the previous version, a wide range of topics is covered from technical issues to clinical risk factors. This review summarizes the evidence about the prognostic value of contemporary methods for HLA antibody detection and identification, as well as the impact of UAM on waiting time, on which these recommendations are based. As no clear criteria could be determined to differentiate potentially harmful from harmless HLA antibodies, the general recommendation is to assign all HLA against which plausible antibodies are found as UAM. There is, however, a need for individualized solutions for highly immunized patients. These revised recommendations provide a list of aspects that need to be considered when assigning UAM to enable a fair and comprehensible procedure and to harmonize risk stratification prior to kidney transplantation between transplant centers. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Malte Ziemann
- Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Barbara Suwelack
- Medizinische Klinik D, University Hospital Münster, Münster, Germany
| | - Bernhard Banas
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Klemens Budde
- Medizinische Klinik m. S. Nephrologie, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Gunilla Einecke
- Clinic for Renal and Hypertensive Disorders, Medizinische Hochschule Hannover, Hannover, Germany
| | - Ingeborg Hauser
- Department of Nephrology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Falko Markus Heinemann
- Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Teresa Kauke
- Division of Thoracic Surgery, Hospital of the Ludwig-Maximilians-University München, München, Germany and Transplantation Center, Hospital of the Ludwig-Maximilians-University München, München, Germany
| | - Reinhard Kelsch
- Institute of Transfusion Medicine and Transplantation Immunology, University Hospital Münster, Münster, Germany
| | - Martina Koch
- General-, Visceral- and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Nils Lachmann
- Institute for Transfusion Medicine, H&I Laboratory, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Reuter
- Medizinische Klinik D, University Hospital Münster, Münster, Germany
| | - Christian Seidl
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Baden-Württemberg-Hessen, Frankfurt am Main, Germany
| | - Urban Sester
- Transplant center, University Hospital of Saarland, Homburg/Saar, Germany
| | - Daniel Zecher
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
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4
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Rosser C, Sage D. Approaches for the characterization of clinically relevant pre-transplant human leucocyte antigen (HLA) antibodies in solid organ transplant patients. Int J Immunogenet 2021; 48:385-402. [PMID: 34346180 DOI: 10.1111/iji.12552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/30/2021] [Accepted: 07/22/2021] [Indexed: 11/27/2022]
Abstract
The avoidance of antibody-mediated rejection (AMR) attributed to human leucocyte antigen (HLA) antibody incompatibility remains an essential function of clinical Histocompatibility and Immunogenetics (H&I) laboratories who are supporting solid organ transplantation. Developments in HLA antibody identification assays over the past thirty years have greatly reduced unexpected positive cellular crossmatches and improved solid organ transplant outcomes. For sensitized patients, the decision to register unacceptable HLA antigen mismatches is often heavily influenced by results from solid phase antibody assays, particularly the Luminex® Single Antigen Bead (SAB) assays, although the clinical relevance of antibodies identified solely by these assays remains unclear. As such, the identification of non-clinically relevant antibodies may proportionally increase the number of unacceptable transplant mismatches registered, with an associated increase in waiting time for a compatible organ. We reflect on the clinical relevance of antibodies identified solely by the Luminex SAB® assays and consider whether the application of additional assays and/or tools could further develop our ability to define the clinical relevance of antibodies identified in patient sera. Improvements in this area would assist equity of access to a compatible transplant for highly sensitized patients awaiting a solid organ transplant.
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Affiliation(s)
- Carla Rosser
- NHS Blood and Transplant (Tooting), Histocompatibility and Immunogenetics, London, UK
| | - Deborah Sage
- NHS Blood and Transplant (Tooting), Histocompatibility and Immunogenetics, London, UK
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5
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Babu A, Khovanova N, Shaw O, Griffin S, Briggs D, Krishnan NS, Fletcher S, Imray C, Seitz A, Baker R, Wellberry-Smith M, Clarke B, Cullen K, Rees T, Edwards F, Burrows E, Howe L, Martin C, Dorling A, Zehnder D, Higgins RM, Mitchell DA, Daga S. C3d-positive donor-specific antibodies have a role in pretransplant risk stratification of cross-match-positive HLA-incompatible renal transplantation: United Kingdom multicentre study. Transpl Int 2020; 33:1128-1139. [PMID: 32479670 DOI: 10.1111/tri.13663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/09/2019] [Accepted: 05/25/2020] [Indexed: 12/21/2022]
Abstract
Anti-HLA-antibody characteristics aid to risk-stratify patients and improve long-term renal graft outcomes. Complement activation by donor-specific antibody (DSA) is an important characteristic that may determine renal allograft outcome. There is heterogeneity in graft outcomes within the moderate to high immunological risk cases (cross-match-positive). We explored the role of C3d-positive DSAs in sub-stratification of cross-match-positive cases and relate to the graft outcomes. We investigated 139 cross-match-positive living-donor renal transplant recipients from four transplant centres in the United Kingdom. C3d assay was performed on serum samples obtained at pretreatment (predesensitization) and Day 14 post-transplant. C3d-positive DSAs were found in 52 (37%) patients at pretreatment and in 37 (27%) patients at Day 14 post-transplant. Median follow-up of patients was 48 months (IQR 20.47-77.57). In the multivariable analysis, pretreatment C3d-positive DSA was independently associated with reduced overall graft survival, the hazard ratio of 3.29 (95% CI 1.37-7.86). The relative risk of death-censored five-year graft failure was 2.83 (95% CI 1.56-5.13). Patients with both pretreatment and Day 14 C3d-positive DSAs had the worst five-year graft survival at 45.5% compared with 87.2% in both pretreatment and Day 14 C3d-negative DSA patients with the relative risk of death-censored five-year graft failure was 4.26 (95% CI 1.79, 10.09). In this multicentre study, we have demonstrated for the first time the utility of C3d analysis as a distinctive biomarker to sub-stratify the risk of poor graft outcome in cross-match-positive living-donor renal transplantation.
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Affiliation(s)
- Adarsh Babu
- Warwick Medical School, University of Warwick, Coventry, UK.,Renal Medicine and Transplantation, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Olivia Shaw
- Department of Histocompatibility and Immunogenetics, Viapath, London, UK
| | - Sian Griffin
- Department of Renal Medicine and Transplantation, University of Wales Hospital, Cardiff, UK
| | | | - Nithya S Krishnan
- Renal Medicine and Transplantation, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Simon Fletcher
- Renal Medicine and Transplantation, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Christopher Imray
- Warwick Medical School, University of Warwick, Coventry, UK.,Renal Medicine and Transplantation, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Adrienne Seitz
- Department of Histocompatibility and Immunogenetics, Leeds Teaching Hospital NHS Trust, Leeds, UK.,Department of Nephrology and Transplantation, St James's University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Richard Baker
- Department of Nephrology and Transplantation, St James's University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Matthew Wellberry-Smith
- Department of Nephrology and Transplantation, St James's University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Brendan Clarke
- Department of Histocompatibility and Immunogenetics, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Katherine Cullen
- Department of Histocompatibility and Immunogenetics, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Tracey Rees
- Welsh Transplantation and Immunogenetics Laboratory, Cardiff, UK
| | - Frankie Edwards
- Welsh Transplantation and Immunogenetics Laboratory, Cardiff, UK
| | - Emma Burrows
- Welsh Transplantation and Immunogenetics Laboratory, Cardiff, UK
| | - Louise Howe
- School of Engineering, University of Warwick, Coventry, UK
| | - Chloe Martin
- School of Engineering, University of Warwick, Coventry, UK
| | - Anthony Dorling
- Department of Renal Medicine and Transplantation, Guys and St Thomas NHS Foundation Trust, London, UK
| | - Daniel Zehnder
- Warwick Medical School, University of Warwick, Coventry, UK.,Department of Nephrology/Acute Medicine, North Cumbria University Hospital NHS Trust, Carlisle, UK
| | - Robert M Higgins
- Warwick Medical School, University of Warwick, Coventry, UK.,Renal Medicine and Transplantation, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Sunil Daga
- Warwick Medical School, University of Warwick, Coventry, UK.,Department of Nephrology and Transplantation, St James's University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
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Fischman C, Fribourg M, Fabrizio G, Cioni M, Comoli P, Nocera A, Cardillo M, Cantarelli C, Gallon L, Petrosyan A, Da Sacco S, Perin L, Cravedi P. Circulating B Cells With Memory and Antibody-Secreting Phenotypes Are Detectable in Pediatric Kidney Transplant Recipients Before the Development of Antibody-Mediated Rejection. Transplant Direct 2019; 5:e481. [PMID: 31579809 PMCID: PMC6739044 DOI: 10.1097/txd.0000000000000914] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 12/18/2022] Open
Abstract
Development of anti-human leukocyte antigen donor-specific antibodies (DSAs) is associated with antibody-mediated rejection (AMR) and reduced allograft survival in kidney transplant recipients. Whether changes in circulating lymphocytes anticipate DSA or AMR development is unclear. METHODS We used time-of-flight mass cytometry to analyze prospectively collected peripheral blood mononuclear cells (PBMC) from pediatric kidney transplant recipients who developed DSA (DSA-positive recipients [DSAPOS], n = 10). PBMC were obtained at 2 months posttransplant, 3 months before DSA development, and at DSA detection. PBMC collected at the same time points posttransplant from recipients who did not develop DSA (DSA-negative recipients [DSANEG], n = 11) were used as controls. RESULTS DSAPOS and DSANEG recipients had similar baseline characteristics and comparable frequencies of total B and T cells. Within DSAPOS recipients, there was no difference in DSA levels (mean fluorescence intensity [MFI]: 13 687 ± 4159 vs 11 375 ± 1894 in DSAPOSAMR-positive recipients (AMRPOS) vs DSAPOSAMR-negative recipients (AMRNEG), respectively; P = 0.630), C1q binding (5 DSAPOSAMRPOS [100%] vs 4 DSAPOSAMRNEG [80%]; P = 1.000), or C3d binding (3 DSAPOSAMRPOS [60%] vs 1 DSAPOSAMRNEG [20%]; P = 0.520) between patients who developed AMR and those who did not. However, DSAPOS patients who developed AMR (n = 5; 18.0 ± 3.6 mo post-DSA detection) had increased B cells with antibody-secreting (IgD-CD27+CD38+; P = 0.002) and memory (IgD-CD27+CD38-; P = 0.003) phenotypes compared with DSANEG and DSAPOSAMRNEG recipients at DSA detection. CONCLUSIONS Despite the small sample size, our comprehensive phenotypic analyses show that circulating B cells with memory and antibody-secreting phenotypes are present at DSA onset, >1 year before biopsy-proven AMR in pediatric kidney transplant recipients.
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Affiliation(s)
- Clara Fischman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Miguel Fribourg
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ginevri Fabrizio
- Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto G. Gaslini, Genova, Italy
| | - Michela Cioni
- Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto G. Gaslini, Genova, Italy
| | - Patrizia Comoli
- Pediatric Hematology/Oncology & Cell Factory, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Arcangelo Nocera
- Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto G. Gaslini, Genova, Italy
| | - Massimo Cardillo
- Department Transplantation Immunology, IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Chiara Cantarelli
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Dipartimento di Medicina e Chirurgia Università di Parma, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy
| | - Lorenzo Gallon
- Department of Medicine, Division of Nephrology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Astgik Petrosyan
- Division of Urology GOFARR Laboratory for Organ Regenerative Research and Cell Therapeutics, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Stefano Da Sacco
- Division of Urology GOFARR Laboratory for Organ Regenerative Research and Cell Therapeutics, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Laura Perin
- Division of Urology GOFARR Laboratory for Organ Regenerative Research and Cell Therapeutics, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Paolo Cravedi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Farkas AM, Baranyi U, Böhmig GA, Unger L, Hopf S, Wahrmann M, Regele H, Mahr B, Schwarz C, Hock K, Pilat N, Kristo I, Mraz J, Lupinek C, Thalhamer J, Bond G, Kuessel L, Wlodek E, Martin J, Clatworthy M, Pettigrew G, Valenta R, Wekerle T. Allograft rejection is associated with development of functional IgE specific for donor MHC antigens. J Allergy Clin Immunol 2019; 143:335-345.e12. [PMID: 30009843 DOI: 10.1016/j.jaci.2018.06.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 06/07/2018] [Accepted: 06/14/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Donor-specific antibodies of the IgG isotype are measured routinely for diagnostic purposes in renal transplant recipients and are associated with antibody-mediated rejection and long-term graft loss. OBJECTIVE This study aimed to investigate whether MHC-specific antibodies of the IgE isotype are induced during allograft rejection. METHODS Anti-MHC/HLA IgE levels were measured in sera of mice grafted with skin or heart transplants from various donor strains and in sera of kidney transplant patients with high levels of HLA IgG. Mediator release was triggered in vitro by stimulating basophils that were coated with murine or human IgE-positive serum, respectively, with specific recombinant MHC/HLA antigens. Kidney tissue samples obtained from organ donors were analyzed by using flow cytometry for cells expressing the high-affinity receptor for IgE (FcεRI). RESULTS Donor MHC class I- and MHC class II-specific IgE was found on acute rejection of skin and heart grafts in several murine strain combinations, as well as during chronic antibody-mediated heart graft rejection. Anti-HLA IgE, including donor HLA class I and II specificities, was identified in a group of sensitized transplant recipients. Murine and human anti-MHC/HLA IgE triggered mediator release in coated basophils on stimulation with specific MHC/HLA antigens. HLA-specific IgE was not linked to atopy, and allergen-specific IgE present in allergic patients did not cross-react with HLA antigens. FcεRI+ cells were found in the human renal cortex and medulla and provide targets for HLA-specific IgE. CONCLUSION These results demonstrate that MHC/HLA-specific IgE develops during an alloresponse and is functional in mediating effector mechanisms.
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Affiliation(s)
- Andreas M Farkas
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Ulrike Baranyi
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria; Cardiac Surgery Laboratory, Medical University of Vienna, Vienna, Austria
| | - Georg A Böhmig
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Lukas Unger
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Hopf
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Markus Wahrmann
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Heinz Regele
- Institute of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - Benedikt Mahr
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Schwarz
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Karin Hock
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Nina Pilat
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Ivan Kristo
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Jasmin Mraz
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Christian Lupinek
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center of Physiology and Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Josef Thalhamer
- Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - Gregor Bond
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Lorenz Kuessel
- Department for Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Elizabeth Wlodek
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
| | - Jack Martin
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
| | - Menna Clatworthy
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Gavin Pettigrew
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center of Physiology and Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Thomas Wekerle
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria.
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Prognostic Value of the Persistence of C1q-Binding Anti-HLA Antibodies in Acute Antibody-Mediated Rejection in Kidney Transplantation. Transplantation 2018; 102:688-698. [PMID: 29135832 DOI: 10.1097/tp.0000000000002002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The differential pathogenicity of anti-HLA donor-specific antibodies (DSAs) is not fully understood. The presence of complement-binding DSAs helps in better defining the prognosis of acute antibody-mediated rejection (ABMR). The evolution of these antibodies after the treatment of ABMR is unknown. METHODS We included patients from the French multicenter RITUX ERAH study diagnosed with acute ABMR within the first year of renal transplantation, with circulating anti-HLA DSAs and treated randomly by rituximab or placebo (and intravenous immunoglobulins, plasma exchange). We centrally analyzed serum samples at the time of ABMR, 3 and 6 months after ABMR, with anti-HLA DSAs specificities and C1q-binding capacity assessment. RESULTS Twenty-five patients were included: 68% had C1q-binding DSAs at the time of ABMR. The presence of C1q-binding DSAs was associated with a poorer evolution of chronic glomerulopathy at 6 months (P = 0.036). The persistence of C1q-binding DSAs at 3 and/or 6 months after ABMR was associated with more severe chronic glomerulopathy (P = 0.006), greater C4d score deposition score at 6 months after ABMR (P = 0.008), and graft loss 5 years after ABMR (P = 0.029). C1q-binding capacity was associated with the DSA MFI but 5 C1q-binding DSAs in 4 patients had low MFI values without a prozone effect. CONCLUSION The presence and persistence of anti-HLA C1q-binding DSAs after ABMR is a detrimental marker, leading to transplant glomerulopathy and graft loss. Assessment of the complement-binding capacities of DSAs could help decide treatment intensification.
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Buttigieg J, Ali H, Sharma A, Halawa A. Positive Luminex and negative flow cytometry in kidney transplantation: a systematic review and meta-analysis. Nephrol Dial Transplant 2018; 34:1950-1960. [DOI: 10.1093/ndt/gfy349] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/10/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
The presence of pre-formed donor-specific antibodies (DSAs) in kidney transplantation is associated with worse overall outcomes compared with DSA-negative transplantation. A positive complement-dependant cytotoxic crossmatch presents a high immunological risk, while a negative flow cytometry crossmatch is at the lower end of the risk spectrum. Yet, the presence of low-level DSA detected by Luminex alone, that is, positive Luminex and negative flow (PLNF) cytometry crossmatch lacks robust scientific exploration. In this systematic review and pooled analysis, we investigate the glomerular filtration rate, acute rejection (AR), graft survival and patient survival of PLNF transplants compared with DSA-negative transplants. Our analysis identified seven retrospective studies consisting of 429 PLNF transplants and 10 677 DSA-negative transplants. Pooled analysis identified no significant difference in the incidence of AR at 1 year [relative risk (RR) = 1.35, 95% confidence interval (CI) 0.90–2.02, Z = 1.46, P = 0.14, I2 = 0%], graft failure at 1 year (RR = 1.66, 95% CI 0.94–2.94, Z = 1.75, P = 0.08, I2 = 23%), graft failure at 5 years (RR = 1.29, 95% CI 0.90–1.87, Z = 1.38, P = 0.17, I2 = 0%), patient mortality at 1 year (RR = 0.89, 95% CI 0.31–2.56, Z = 0.22, P = 0.82, I2 = 0%) and patient mortality at 5 years (RR = 1.76, 95% CI 0.48–6.48, Z = 0.85, P = 0.39, I2 = 61%). Pooled analysis of graft function was not possible due to insufficient data. Current evidence suggests that low-level DSA detected by Luminex alone does not pose significant risk at least in the short–medium term. Considering the shortage of kidney transplants and the ever-increasing waiting time, the avoidance of PLNF transplants may be unwarranted especially in patients who have been enlisted for a long time.
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Affiliation(s)
- Jesmar Buttigieg
- Renal Division, Department of Medicine, Mater Dei Hospital, Malta
- Faculty of Health and Life Science, Institute of Learning and Teaching, University of Liverpool, Liverpool, UK
| | - Hatem Ali
- Faculty of Health and Life Science, Institute of Learning and Teaching, University of Liverpool, Liverpool, UK
- Department of Renal Medicine, Royal Wolverhampton Hospitals NHS Foundation Trust, Wolverhampton, UK
| | - Ajay Sharma
- Faculty of Health and Life Science, Institute of Learning and Teaching, University of Liverpool, Liverpool, UK
- Renal Transplant Unit, Royal Liverpool University Hospital, NHS Trust, Liverpool, UK
| | - Ahmed Halawa
- Faculty of Health and Life Science, Institute of Learning and Teaching, University of Liverpool, Liverpool, UK
- Renal Transplant Unit, Sheffield Teaching Hospitals, NHS Trust, Sheffield, UK
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Distribution of Anti-ABO Immunoglobulin G Subclass and C1q Antibody in ABO-incompatible Kidney Transplantation. Transplant Proc 2018; 50:1063-1067. [PMID: 29731066 DOI: 10.1016/j.transproceed.2018.01.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/22/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION To investigate the correlation between serum anti-ABO immunoglobulin G (IgG) and IgG subclasses, anti-ABO IgG subclasses were measured by flow cytometry (FCM) in ABO-incompatible (ABOi) kidney transplant recipients. We also evaluated baseline anti-ABO C1q antibody. METHOD Baseline anti-ABO IgG titers were measured by both FCM and column agglutination technique methods in 18 ABOi kidney transplant recipients. The mean florescence intensity (MFI) ratios of baseline anti-ABO IgG subclasses and anti-ABO C1q antibody were obtained by FCM and followed-up after rituximab treatment, each plasmapheresis (PP) session, and kidney transplantation. Correlation between the values of IgG subclass and total IgG titer was analyzed. RESULTS The baseline MFI ratios of total IgG, IgG1, IgG2, IgG3, and IgG4 were 202.46, 62.41, 30.01, 1.04, and 1.13, respectively. The MFI ratios of IgG1, IgG2, and total IgG measured at baseline and pre-PP were positively correlated with the baseline ABO titer was measured using the column agglutination technique. The numbers of PP sessions to reach the target titer were correlated with the baseline IgG and IgG1 levels. IgG1 and IgG2 as well as total IgG were removed effectively after serial PP. Anti-ABO C1q antibody was neither detected nor correlated with total IgG and any IgG subclasses. CONCLUSIONS Our findings suggest that IgG1 and IgG2 are the dominant IgG subclass in ABOi kidney transplant recipients. Baseline levels of IgG1 and IgG2 were correlated with baseline total IgG titer. However, anti-ABO C1q antibody was not detected in the present study.
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Bouquegneau A, Loheac C, Aubert O, Bouatou Y, Viglietti D, Empana J, Ulloa C, Hassan Murad M, Legendre C, Glotz D, Jackson AM, Zeevi A, Schaub S, Taupin J, Reed EF, Friedewald JJ, Tyan DB, Süsal C, Shapiro R, Woodle ES, Hidalgo LG, O’Leary J, Montgomery RA, Kobashigawa J, Jouven X, Jabre P, Lefaucheur C, Loupy A. Complement-activating donor-specific anti-HLA antibodies and solid organ transplant survival: A systematic review and meta-analysis. PLoS Med 2018; 15:e1002572. [PMID: 29799874 PMCID: PMC5969739 DOI: 10.1371/journal.pmed.1002572] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/26/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Anti-human leukocyte antigen donor-specific antibodies (anti-HLA DSAs) are recognized as a major barrier to patients' access to organ transplantation and the major cause of graft failure. The capacity of circulating anti-HLA DSAs to activate complement has been suggested as a potential biomarker for optimizing graft allocation and improving the rate of successful transplantations. METHODS AND FINDINGS To address the clinical relevance of complement-activating anti-HLA DSAs across all solid organ transplant patients, we performed a meta-analysis of their association with transplant outcome through a systematic review, from inception to January 31, 2018. The primary outcome was allograft loss, and the secondary outcome was allograft rejection. A comprehensive search strategy was conducted through several databases (Medline, Embase, Cochrane, and Scopus). A total of 5,861 eligible citations were identified. A total of 37 studies were included in the meta-analysis. Studies reported on 7,936 patients, including kidney (n = 5,991), liver (n = 1,459), heart (n = 370), and lung recipients (n = 116). Solid organ transplant recipients with circulating complement-activating anti-HLA DSAs experienced an increased risk of allograft loss (pooled HR 3.09; 95% CI 2.55-3.74, P = 0.001; I2 = 29.3%), and allograft rejection (pooled HR 3.75; 95% CI: 2.05-6.87, P = 0.001; I2 = 69.8%) compared to patients without complement-activating anti-HLA DSAs. The association between circulating complement-activating anti-HLA DSAs and allograft failure was consistent across all subgroups and sensitivity analyses. Limitations of the study are the observational and retrospective design of almost all included studies, the higher proportion of kidney recipients compared to other solid organ transplant recipients, and the inclusion of fewer studies investigating allograft rejection. CONCLUSIONS In this study, we found that circulating complement-activating anti-HLA DSAs had a significant deleterious impact on solid organ transplant survival and risk of rejection. The detection of complement-activating anti-HLA DSAs may add value at an individual patient level for noninvasive biomarker-guided risk stratification. TRIAL REGISTRATION National Clinical Trial protocol ID: NCT03438058.
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Affiliation(s)
- Antoine Bouquegneau
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Department of Nephrology, Dialysis and Transplantation, CHU de Liège, Liège, Belgium
| | - Charlotte Loheac
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
| | - Olivier Aubert
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Department of Kidney Transplantation, Necker Hospital, Paris Descartes University, and Assistance Publique–Hôpitaux de Paris (AP–HP), Paris, France
| | - Yassine Bouatou
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Division of Nephrology, Geneva University Hospitals, Geneva, Switzerland
| | - Denis Viglietti
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Department of Nephrology and Kidney Transplantation, Saint–Louis Hospital, Paris Diderot University, AP–HP, Paris, France
| | - Jean–Philippe Empana
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
| | - Camilo Ulloa
- Hospital Barros Luco Trudeau, Santiago, Chile et Clinica Alemana de Santiago, Chile
| | - Mohammad Hassan Murad
- Mayo Clinic Evidence–based Practice Center, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Christophe Legendre
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Department of Kidney Transplantation, Necker Hospital, Paris Descartes University, and Assistance Publique–Hôpitaux de Paris (AP–HP), Paris, France
| | - Denis Glotz
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Department of Nephrology and Kidney Transplantation, Saint–Louis Hospital, Paris Diderot University, AP–HP, Paris, France
| | - Annette M. Jackson
- Immunogenetics Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Adriana Zeevi
- Department of Pathology, Surgery and Immunology at University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Stephan Schaub
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Jean–Luc Taupin
- Department of Immunology and Histocompatibility, CHU Paris–GH St–Louis Lariboisière, Paris, France
| | - Elaine F. Reed
- Department of Pathology and Laboratory Medicine, UCLA Immunogenetics Center, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - John J. Friedewald
- Northwestern University Feinberg School of Medicine, Comprehensive Transplant Center, Division of Transplant Surgery, Chicago, Illinois, United states of America
| | - Dolly B. Tyan
- Division of Nephrology, Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Caner Süsal
- Institute of Immunology, Heidelberg University, Department of Transplantation Immunology, Heidelberg, Germany
| | - Ron Shapiro
- Kidney/Pancreas Transplant Program, Mount Sinai Hospital, Recanati Miller Transplantation Institute, New York, New York, United States of America
| | - E. Steve Woodle
- Division of Transplantation, Department of Surgery, and Division of Hematology and Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Luis G. Hidalgo
- Department of Laboratory Medicine and Pathology and Alberta Transplant Applied Genomics Center, Edmonton, Alberta, Canada
| | - Jacqueline O’Leary
- Annette C. & Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, United States of America
| | - Robert A. Montgomery
- The NYU Transplant Institute, New York University Langone Medical Center, New York, New York, United States of America
| | - Jon Kobashigawa
- Cedars–Sinai Heart Institute, Los Angeles, California, United States of America
| | - Xavier Jouven
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Department of Cardiology and Global Health Unit European Georges Pompidou Hospital, Paris
| | - Patricia Jabre
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- SAMU of Paris, Necker Hospital Paris, France
- Paris Descartes University, Paris, France
- AP–HP, Paris, France
| | - Carmen Lefaucheur
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Department of Nephrology and Kidney Transplantation, Saint–Louis Hospital, Paris Diderot University, AP–HP, Paris, France
| | - Alexandre Loupy
- Paris Translational Research Center for Organ Transplantation INSERM Unit 970, Paris, France
- Department of Kidney Transplantation, Necker Hospital, Paris Descartes University, and Assistance Publique–Hôpitaux de Paris (AP–HP), Paris, France
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Sullivan HC, Gebel HM, Bray RA. Understanding solid-phase HLA antibody assays and the value of MFI. Hum Immunol 2017; 78:471-480. [DOI: 10.1016/j.humimm.2017.05.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 01/10/2023]
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Sullivan HC, Liwski RS, Bray RA, Gebel HM. The Road to HLA Antibody Evaluation: Do Not Rely on MFI. Am J Transplant 2017; 17:1455-1461. [PMID: 28199773 PMCID: PMC8663029 DOI: 10.1111/ajt.14229] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/22/2017] [Accepted: 02/04/2017] [Indexed: 01/25/2023]
Abstract
Technological advances in HLA laboratory testing undoubtedly improved the sensitivity and specificity of HLA antibody assessment but not without introducing a set of challenges regarding data interpretation. In particular, the introduction of solid-phase single-antigen bead (SAB) antibody assessment brought the belief that mean fluorescence intensity (MFI) was a quantifiable value. As such, MFI levels heavily influenced HLA antibody reporting, monitoring, and clinical practice. However, given that SAB testing was neither intended for nor approved to be quantifiable, is the use of MFI in current clinical and laboratory practice valid? What, if anything, does this numerical value actually reveal about the pathogenic potential of the antibody? What are the pitfalls and caveats associated with reporting MFI? Herein, we travel the road to HLA antibody assessment and explore the reliability of MFI values to make clinical decisions.
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Affiliation(s)
- H. C. Sullivan
- Department of Pathology, Emory University Hospital, Atlanta, GA
| | - R. S. Liwski
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - R. A. Bray
- Department of Pathology, Emory University Hospital, Atlanta, GA
| | - H. M. Gebel
- Department of Pathology, Emory University Hospital, Atlanta, GA,Corresponding author: Howard M. Gebel,
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Diagnostic Contribution of Donor-Specific Antibody Characteristics to Uncover Late Silent Antibody-Mediated Rejection-Results of a Cross-Sectional Screening Study. Transplantation 2017; 101:631-641. [PMID: 27120452 DOI: 10.1097/tp.0000000000001195] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Circulating donor-specific antibodies (DSA) detected on bead arrays may not inevitably indicate ongoing antibody-mediated rejection (AMR). Here, we investigated whether detection of complement-fixation, in parallel to IgG mean fluorescence intensity (MFI), allows for improved prediction of AMR. METHODS Our study included 86 DSA+ kidney transplant recipients subjected to protocol biopsy, who were identified upon cross-sectional antibody screening of 741 recipients with stable graft function at 6 months or longer after transplantation. IgG MFI was analyzed after elimination of prozone effect, and complement-fixation was determined using C1q, C4d, or C3d assays. RESULTS Among DSA+ study patients, 44 recipients (51%) had AMR, 24 of them showing C4d-positive rejection. Although DSA number or HLA class specificity were not different, patients with AMR or C4d + AMR showed significantly higher IgG, C1q, and C3d DSA MFI than nonrejecting or C4d-negative patients, respectively. Overall, the predictive value of DSA characteristics was moderate, whereby the highest accuracy was computed for peak IgG MFI (AMR, 0.73; C4d + AMR, 0.71). Combined analysis of antibody characteristics in multivariate models did not improve AMR prediction. CONCLUSIONS We estimate a 50% prevalence of silent AMR in DSA+ long-term recipients and conclude that assessment of IgG MFI may add predictive accuracy, without an independent diagnostic advantage of detecting complement-fixation.
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Shimizu T, Toma H, Hayakawa N, Shibahara R, Ishiyama R, Hayashida A, Fujimori D, Tsunoyama K, Ikezawa E, Kitajima S, Iida S, Ishida H, Tanabe K, Honda K, Koike J. Clinical and pathological analyses of interstitial fibrosis and tubular atrophy cases after kidney transplantation. Nephrology (Carlton) 2017; 21 Suppl 1:26-30. [PMID: 26972969 DOI: 10.1111/nep.12766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 11/26/2022]
Abstract
AIM We carried out a clinicopathological analysis of cases presenting with interstitial fibrosis and tubular atrophy (IF/TA) after renal transplantation in an attempt to clarify the mechanisms underlying the development and prognostic significance of IF/TA. METHODS IF/TA was diagnosed in 35 renal allograft biopsy specimens (BS) obtained from 35 renal transplant recipients under follow up at the Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, between January 2014 and March 2015. RESULTS IF/TA was diagnosed at a median of 39.9 months after the transplantation. Among the 35 patients with IF/TA, 19 (54%) had a history of acute rejection. Among the 35 BS showing evidence of IF/TA, the IF/TA was grade I in 25, grade II in 9, and grade III in 1. Arteriosclerosis of the middle-sized arteries was observed in 30 BS (86%). We then classified the 35 BS showing evidence of IF/TA according to their overall histopathological features, as follows; IF/TA alone (6 BS; 17%), IF/TA + medullary ray injury (12 BS; 34%), and IF/TA + rejection (12 BS; 34%). Loss of the renal allograft occurred during the observation period in one of the patients (3%). Of the remaining patients with functioning grafts, deterioration of the renal allograft function after the biopsies occurred in 15 patients (43%). CONCLUSIONS The results of our study suggests that rejection contributes to IF/TA in 30-40% of cases, medullary ray injury in 30-40% of cases, and nonspecific injury in 20% of cases. IF/TA contributes significantly to deterioration of renal allograft function.
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Affiliation(s)
- Tomokazu Shimizu
- Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, Saitama, Japan
| | - Hiroshi Toma
- Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, Saitama, Japan
| | - Nozomi Hayakawa
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Rumi Shibahara
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryou Ishiyama
- Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, Saitama, Japan
| | - Akihiro Hayashida
- Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, Saitama, Japan
| | - Daiji Fujimori
- Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, Saitama, Japan
| | - Kuniko Tsunoyama
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Eri Ikezawa
- Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, Saitama, Japan
| | - Shoji Kitajima
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shoichi Iida
- Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, Saitama, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuho Honda
- Department of Anatomy, Showa University, Tokyo, Japan
| | - Junki Koike
- Department of Pathology, Kawasaki Municipal Tama Hospital, Kanagawa, Japan
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Malheiro J, Tafulo S, Dias L, Martins LS, Fonseca I, Beirão I, Castro-Henriques A, Cabrita A. Determining donor-specific antibody C1q-binding ability improves the prediction of antibody-mediated rejection in human leucocyte antigen-incompatible kidney transplantation. Transpl Int 2016; 30:347-359. [PMID: 27717025 DOI: 10.1111/tri.12873] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 08/10/2016] [Accepted: 09/30/2016] [Indexed: 11/28/2022]
Abstract
Detrimental impact of preformed donor-specific antibodies (DSAs) against human leucocyte antigens on outcomes after kidney transplantation are well documented, however, the value of their capacity to bind complement for predicting antibody-mediated rejection (AMR) and graft survival still needs to be confirmed. We aimed to study DSA characteristics (strength and C1q binding) that might distinguish harmful DSA from clinically irrelevant ones. We retrospectively studied 60 kidney-transplanted patients with preformed DSA detected by single antigen bead (SAB) assays (IgG and C1q kits), from a cohort of 517 kidney graft recipients (124 with detectable anti-HLA antibodies). Patients were divided into DSA strength (MFI < vs. ≥ 15 000) and C1q-binding ability. AMR frequency was high (30%) and it increased with DSA strength (P = 0.002) and C1q+ DSA (P < 0.001). The performance of DSA C1q-binding ability as a predictor of AMR was better than DSA strength (diagnostic odds ratio 16.3 vs. 6.4, respectively). Furthermore, a multivariable logistic regression showed that C1q+ DSA was a risk factor for AMR (OR = 16.80, P = 0.001), while high MFI DSAs were not. Graft survival was lower in high MFI C1q+ DSA in comparison with patients with C1q- high or low MFI DSA (at 6 years, 38%, 83% and 80%, respectively; P = 0.001). Both DSA strength and C1q-binding ability assessment seem valuable for improving pretransplant risk assessment. Since DSA C1q-binding ability was a better predictor of AMR and correlated with graft survival, C1q-SAB may be a particularly useful tool.
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Affiliation(s)
- Jorge Malheiro
- Nephrology and Kidney Transplantation Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.,Unit for Multidisciplinary Investigation in Biomedicine (UMIB), Porto, Portugal
| | - Sandra Tafulo
- Centro do Sangue e Transplantação do Porto, Porto, Portugal
| | - Leonídio Dias
- Nephrology and Kidney Transplantation Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - La Salete Martins
- Nephrology and Kidney Transplantation Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.,Unit for Multidisciplinary Investigation in Biomedicine (UMIB), Porto, Portugal
| | - Isabel Fonseca
- Nephrology and Kidney Transplantation Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.,Unit for Multidisciplinary Investigation in Biomedicine (UMIB), Porto, Portugal
| | - Idalina Beirão
- Nephrology and Kidney Transplantation Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.,Unit for Multidisciplinary Investigation in Biomedicine (UMIB), Porto, Portugal
| | - António Castro-Henriques
- Nephrology and Kidney Transplantation Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.,Unit for Multidisciplinary Investigation in Biomedicine (UMIB), Porto, Portugal
| | - António Cabrita
- Nephrology and Kidney Transplantation Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
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Schwaiger E, Eskandary F, Kozakowski N, Bond G, Kikić Ž, Yoo D, Rasoul-Rockenschaub S, Oberbauer R, Böhmig GA. Deceased donor kidney transplantation across donor-specific antibody barriers: predictors of antibody-mediated rejection. Nephrol Dial Transplant 2016; 31:1342-51. [PMID: 27190362 DOI: 10.1093/ndt/gfw027] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 01/28/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Apheresis-based desensitization allows for successful transplantation across major immunological barriers. For donor-specific antibody (DSA)- and/or crossmatch-positive transplantation, however, it has been shown that even intense immunomodulation may not completely prevent antibody-mediated rejection (ABMR). METHODS In this study, we evaluated transplant outcomes in 101 DSA+ deceased donor kidney transplant recipients (transplantation between 2009 and 2013; median follow-up: 24 months) who were subjected to immunoadsorption (IA)-based desensitization. Treatment included a single pre-transplant IA session, followed by anti-lymphocyte antibody and serial post-transplant IA. In 27 cases, a positive complement-dependent cytotoxicity crossmatch (CDCXM) was rendered negative immediately before transplantation. Seventy-four of the DSA+ recipients had a negative CDCXM already before IA. RESULTS Three-year death-censored graft survival in DSA+ patients was significantly worse than in 513 DSA- recipients transplanted during the same period (79 versus 88%, P = 0.008). Thirty-three DSA+ recipients (33%) had ABMR. While a positive baseline CDCXM showed only a trend towards higher ABMR rates (41 versus 30% in CDCXM- recipients, P = 0.2), DSA mean fluorescence intensity (MFI) in single bead assays significantly associated with rejection, showing 20 versus 71% ABMR rates at <5000 versus >15 000 peak DSA MFI. The predictive value of MFI was moderate, with the highest accuracy at a median of 13 300 MFI (after cross-validation: 0.72). Other baseline variables, including CDC assay results, human leukocyte antigen mismatch, prior transplantation or type of induction treatment, did not add independent predictive information. CONCLUSIONS IA-based desensitization failed to prevent ABMR in a considerable number of DSA+ recipients. Assessing DSA MFI may help stratify risk of rejection, supporting its use as a guide to organ allocation and individualized treatment.
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Affiliation(s)
- Elisabeth Schwaiger
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Farsad Eskandary
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria Alberta Transplant Applied Genomics Centre, ATAGC, University of Alberta, Edmonton, AB, Canada
| | - Nicolas Kozakowski
- Department of Clinical Pathology, Medical University Vienna, Vienna, Austria
| | - Gregor Bond
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Željko Kikić
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Daniel Yoo
- Transcriptome Sciences Inc., 250 Heritage Medical Research Centre, University of Alberta, Edmonton, AB, Canada
| | - Susanne Rasoul-Rockenschaub
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
| | - Rainer Oberbauer
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Georg A Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria
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Bachelet T, Visentin J, Guidicelli G, Merville P, Couzi L, Taupin JL. Anti-HLA donor-specific antibodies are not created equally. Don't forget the flow…. Transpl Int 2016; 29:508-10. [DOI: 10.1111/tri.12745] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Thomas Bachelet
- Clinique Saint Augustin-CTMR; Bordeaux France
- Department of Nephrology, Transplantation, and Dialysis; Bordeaux University Hospital; Bordeaux France
| | - Jonathan Visentin
- Immunology and Immunogenetics Laboratory; Bordeaux University Hospital; Bordeaux France
- National Center of Scientific Research; Mix Unit of Research 5164; Bordeaux France
- Bordeaux University; Bordeaux France
| | - Gwendaline Guidicelli
- Immunology and Immunogenetics Laboratory; Bordeaux University Hospital; Bordeaux France
| | - Pierre Merville
- Department of Nephrology, Transplantation, and Dialysis; Bordeaux University Hospital; Bordeaux France
- National Center of Scientific Research; Mix Unit of Research 5164; Bordeaux France
- Bordeaux University; Bordeaux France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, and Dialysis; Bordeaux University Hospital; Bordeaux France
- National Center of Scientific Research; Mix Unit of Research 5164; Bordeaux France
- Bordeaux University; Bordeaux France
| | - Jean-Luc Taupin
- Immunology and Immunogenetics Laboratory; Bordeaux University Hospital; Bordeaux France
- National Center of Scientific Research; Mix Unit of Research 5164; Bordeaux France
- Bordeaux University; Bordeaux France
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Kozakowski N, Herkner H, Böhmig GA, Regele H, Kornauth C, Bond G, Kikić Ž. The diffuse extent of peritubular capillaritis in renal allograft rejection is an independent risk factor for graft loss. Kidney Int 2015; 88:332-40. [DOI: 10.1038/ki.2015.64] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 01/05/2015] [Accepted: 01/22/2015] [Indexed: 01/06/2023]
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21
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Thomas KA, Valenzuela NM, Gjertson D, Mulder A, Fishbein MC, Parry GC, Panicker S, Reed EF. An Anti-C1s Monoclonal, TNT003, Inhibits Complement Activation Induced by Antibodies Against HLA. Am J Transplant 2015; 15:2037-49. [PMID: 25904443 PMCID: PMC4654252 DOI: 10.1111/ajt.13273] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/10/2015] [Accepted: 02/17/2015] [Indexed: 01/25/2023]
Abstract
Antibody-mediated rejection (AMR) of solid organ transplants (SOT) is characterized by damage triggered by donor-specific antibodies (DSA) binding donor Class I and II HLA (HLA-I and HLA-II) expressed on endothelial cells. While F(ab')2 portions of DSA cause cellular activation and proliferation, Fc regions activate the classical complement cascade, resulting in complement deposition and leukocyte recruitment, both hallmark features of AMR. We characterized the ability of an anti-C1s monoclonal antibody, TNT003, to inhibit HLA antibody (HLA-Ab)-induced complement activation. Complement deposition induced by HLA-Ab was evaluated using novel cell- and bead-based assays. Human aortic endothelial cells (HAEC) were cultured with HLA-Ab and human complement; production of activated complement proteins was measured by flow cytometry. Additionally, C3d deposition was measured on single antigen beads (SAB) mixed with HLA-Ab and human complement. TNT003 inhibited HLA-Ab mediated complement deposition on HAEC in a concentration-dependent manner; C3a, C4a and C5a anaphylatoxin production was also diminished by TNT003. Finally, TNT003 blocked C3d deposition induced by Class I (HLAI-Ab)- and Class II (HLAII-Ab)-specific antibodies on SAB. These data suggest TNT003 may be useful for modulating the effects of DSA, as TNT003 inhibits complement deposition and split product formation generated by HLA-I/II-Ab in vitro.
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Affiliation(s)
- K A Thomas
- Department of Pathology and Laboratory Medicine, University of CaliforniaLos Angeles, CA
| | - N M Valenzuela
- Department of Pathology and Laboratory Medicine, University of CaliforniaLos Angeles, CA
| | - D Gjertson
- Department of Pathology and Laboratory Medicine, University of CaliforniaLos Angeles, CA
| | - A Mulder
- Department of Immunohematology and Blood Transfusion, Leiden University Medical CenterLeiden, the Netherlands
| | - M C Fishbein
- Department of Pathology and Laboratory Medicine, University of CaliforniaLos Angeles, CA
| | - G C Parry
- True North Therapeutics, Inc.South San Francisco, CA
| | - S Panicker
- True North Therapeutics, Inc.South San Francisco, CA
| | - E F Reed
- Department of Pathology and Laboratory Medicine, University of CaliforniaLos Angeles, CA,*Corresponding author: Elaine F. Reed,
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22
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Böhmig GA, Kikic Z, Wahrmann M, Eskandary F, Aliabadi AZ, Zlabinger GJ, Regele H, Feucht HE. Detection of alloantibody-mediated complement activation: A diagnostic advance in monitoring kidney transplant rejection? Clin Biochem 2015; 49:394-403. [PMID: 26118475 DOI: 10.1016/j.clinbiochem.2015.05.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 05/23/2015] [Accepted: 05/28/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Antibody-mediated rejection (ABMR) is an important cause of kidney allograft injury. In the last two decades, detection of complement split product C4d along transplant capillaries, a footprint of antibody-mediated classical complement activation, has evolved as a useful diagnostic marker of ABMR. While it was recognized that ABMR may occur also in the absence of C4d, numerous studies have shown that C4d deposition may indicate a more severe rejection phenotype associated with poor graft survival. Such studies suggest a possible diagnostic benefit of ex vivo monitoring the complement-activating capability of circulating alloantibodies. DESIGN AND METHODS We reviewed the literature between 1993 and 2015, focusing on in vivo (biopsy work-up) and in vitro detection (modified bead array technology) of HLA antibody-triggered classical complement activation in kidney transplantation. RESULTS Precise HLA antibody detection methods, in particular Luminex-based single antigen bead (SAB) assays, have provided a valuable basis for the design of techniques for in vitro detection of HLA antibody-triggered complement activation reflected by C1q, C4 or C3 split product deposition to the bead surface. Establishing such assays it was recognized that deposition of complement products to SAB, which critically depends on antibody binding strength, may be a cardinal trigger of the prozone effect, a troublesome in vitro artifact caused by a steric interference with IgG detection reagents. False-low IgG results, especially on SAB with extensive antibody binding, have to be considered when interpreting studies analyzing the diagnostic value of complement in relation to standard IgG detection. Levels of complement-fixing donor-specific antibodies (DSA) were shown to correlate with the results of standard crossmatch tests, suggesting potential application for crossmatch prediction. Moreover, while the utility of pre-transplant complement detection, at least in crossmatch-negative transplant recipients, is controversially discussed, a series of studies have shown that the appearance of post-transplant complement-fixing DSA may be associated with C4d deposition in transplant capillaries and a particular risk of graft failure. CONCLUSIONS The independent value of modified single antigen bead assays, as compared to a careful analysis of standard IgG detection, which may be affected considerably by complement dependent artifacts, needs to be clarified. Whether they have the potential to improve the predictive accuracy of our current diagnostic repertoire warrants further study.
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Affiliation(s)
- Georg A Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Zeljko Kikic
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Markus Wahrmann
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Farsad Eskandary
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Arezu Z Aliabadi
- Department of Cardiac Surgery, Medical University Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Gerhard J Zlabinger
- Institute of Immunology, Medical University Vienna, Lazarettgasse 19, A-1090 Vienna, Austria
| | - Heinz Regele
- Clinical Institute of Pathology, Medical University Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Helmut E Feucht
- Department of Organ Transplantation/Nephrology, Fachklinik Bad Heilbrunn, Wörnerweg 30, 83670 Bad Heilbrunn, Germany
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Pouliquen E, Koenig A, Chen CC, Sicard A, Rabeyrin M, Morelon E, Dubois V, Thaunat O. Recent advances in renal transplantation: antibody-mediated rejection takes center stage. F1000PRIME REPORTS 2015; 7:51. [PMID: 26097724 PMCID: PMC4447042 DOI: 10.12703/p7-51] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Overlooked for decades, antibodies have taken center stage in renal transplantation and are now widely recognized as the first cause of allograft failure. Diagnosis of antibody-mediated rejection has considerably improved with identification of antibody-mediated lesions in graft biopsies and advances made in the detection of circulating donor-specific antibodies. Unfortunately, this progress has not yet translated into better outcomes for patients. Indeed, in the absence of a drug able to suppress antibody generation by plasma cells, available therapies can only slow down graft destruction. This review provides an overview of the current knowledge of antibody-mediated rejection and discusses future interesting research directions.
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Affiliation(s)
- Eric Pouliquen
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
| | - Alice Koenig
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
| | - Chien Chia Chen
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
| | - Antoine Sicard
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
| | - Maud Rabeyrin
- Laboratoire d‘anatomopathologie, Hospices Civils de Lyon, Hôpital Edouard HerriotLyonFrance
| | - Emmanuel Morelon
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
| | - Valérie Dubois
- Laboratoire d‘Histocompatibilité, Etablissement Français du SangLyonFrance
| | - Olivier Thaunat
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie CliniqueLyonFrance
- Institut National de la Santé et de la Recherche MédicaleU1111, LyonFrance
- Unité de Formation et de Recherche Lyon Est, Université de LyonLyonFrance
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Duhamel P, Suberbielle C, Grimbert P, Leclerc T, Jacquelinet C, Audry B, Bargues L, Charron D, Bey E, Lantieri L, Hivelin M. Anti-HLA sensitization in extensively burned patients: extent, associated factors, and reduction in potential access to vascularized composite allotransplantation. Transpl Int 2015; 28:582-93. [PMID: 25683513 DOI: 10.1111/tri.12540] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/03/2014] [Accepted: 02/06/2015] [Indexed: 12/21/2022]
Abstract
Extensively burned patients receive iterative blood transfusions and skin allografts that often lead to HLA sensitization, and potentially impede access to vascularized composite allotransplantation (VCA). In this retrospective, single-center study, anti-HLA sensitization was measured by single-antigen-flow bead analysis in patients with deep, second- and third-degree burns over ≥40% total body surface area (TBSA). Association of HLA sensitization with blood transfusions, skin allografts, and pregnancies was analyzed by bivariate analysis. The eligibility for transplantation was assessed using calculated panel reactive antibodies (cPRA). Twenty-nine patients aged 32 ± 14 years, including 11 women, presented with a mean burned TBSA of 54 ± 11%. Fifteen patients received skin allografts, comprising those who received cryopreserved (n = 3) or glycerol-preserved (n = 7) allografts, or both (n = 5). An average 36 ± 13 packed red blood cell (PRBC) units were transfused per patient. In sera samples collected 38 ± 13 months after the burns, all patients except one presented with anti-HLA antibodies, of which 13 patients (45%) had complement-fixing antibodies. Eighteen patients (62%) were considered highly sensitized (cPRA≥85%). Cryopreserved, but not glycerol-preserved skin allografts, history of pregnancy, and number of PRBC units were associated with HLA sensitization. Extensively burned patients may become highly HLA sensitized during acute care and hence not qualify for VCA. Alternatives to skin allografts might help preserve their later access to VCA.
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Affiliation(s)
- Patrick Duhamel
- Service de Chirurgie Plastique, Centre de Traitement des Brûlés, Hôpital d'Instruction des Armées Percy, Clamart Cedex, France
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Pankewycz O, Soliman K, Laftavi MR. The increasing clinical importance of alloantibodies in kidney transplantation. Immunol Invest 2014; 43:775-89. [DOI: 10.3109/08820139.2014.910016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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27
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Li X, Zhuang S. Recent advances in renal interstitial fibrosis and tubular atrophy after kidney transplantation. FIBROGENESIS & TISSUE REPAIR 2014; 7:15. [PMID: 25285155 PMCID: PMC4185272 DOI: 10.1186/1755-1536-7-15] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 08/29/2014] [Indexed: 01/05/2023]
Abstract
Although kidney transplantation has been an important means for the treatment of patients with end stage of renal disease, the long-term survival rate of the renal allograft remains a challenge. The cause of late renal allograft loss, once known as chronic allograft nephropathy, has been renamed “interstitial fibrosis and tubular atrophy” (IF/TA) to reflect the histologic pattern seen on biopsy. The mechanisms leading to IF/TA in the transplanted kidney include inflammation, activation of renal fibroblasts, and deposition of extracellular matrix proteins. Identifying the mediators and factors that trigger IF/TA may be useful in early diagnosis and development of novel therapeutic strategies for improving long-term renal allograft survival and patient outcomes. In this review, we highlight the recent advances in our understanding of IF/TA from three aspects: pathogenesis, diagnosis, and treatment.
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Affiliation(s)
- Xiaojun Li
- Department of Nephrology, Tongji University School of Medicine, Shanghai East Hospital, Shanghai, China
| | - Shougang Zhuang
- Department of Nephrology, Tongji University School of Medicine, Shanghai East Hospital, Shanghai, China ; Department of Medicine, Alpert Medical School of Brown University, Rhode Island Hospital, Middle House 301, 593 Eddy Street, Providence, RI 02903, USA
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28
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Sicard A, Ducreux S, Rabeyrin M, Couzi L, McGregor B, Badet L, Scoazec JY, Bachelet T, Lepreux S, Visentin J, Merville P, Fremeaux-Bacchi V, Morelon E, Taupin JL, Dubois V, Thaunat O. Detection of C3d-binding donor-specific anti-HLA antibodies at diagnosis of humoral rejection predicts renal graft loss. J Am Soc Nephrol 2014; 26:457-67. [PMID: 25125383 DOI: 10.1681/asn.2013101144] [Citation(s) in RCA: 203] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Antibody-mediated rejection (AMR) is a major cause of kidney graft loss, yet assessment of individual risk at diagnosis is impeded by the lack of a reliable prognosis assay. Here, we tested whether the capacity of anti-HLA antibodies to bind complement components allows accurate risk stratification at the time of AMR diagnosis. Among 938 kidney transplant recipients for whom a graft biopsy was performed between 2004 and 2012 at the Lyon University Hospitals, 69 fulfilled the diagnosis criteria for AMR and were enrolled. Sera banked at the time of the biopsy were screened for the presence of donor-specific anti-HLA antibodies (DSAs) and their ability to bind C1q and C3d using flow bead assays. In contrast with C4d graft deposition, the presence of C3d-binding DSA was associated with a higher risk of graft loss (P<0.001). Despite similar trend, the difference did not reach significance with a C1q-binding assay (P=0.06). The prognostic value of a C3d-binding assay was further confirmed in an independent cohort of 39 patients with AMR (P=0.04). Patients with C3d-binding antibodies had worse eGFR and higher DSA mean fluorescence intensity. In a multivariate analysis, only eGFR <30 ml/min per 1.73 m(2) (hazard ratio [HR], 3.56; 95% confidence interval [CI], 1.46 to 8.70; P=0.005) and the presence of circulating C3d-binding DSA (HR, 2.80; 95% CI, 1.12 to 6.95; P=0.03) were independent predictors for allograft loss at AMR diagnosis. We conclude that assessment of the C3d-binding capacity of DSA at the time of AMR diagnosis allows for identification of patients at risk for allograft loss.
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Affiliation(s)
- Antoine Sicard
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie Clinique, Lyon, France; Institut National de la Santé et de la Recherche Médicale U1111, Lyon, France; Unité de Formation et de Recherche Lyon Est, Université de Lyon, Lyon, France
| | - Stéphanie Ducreux
- Laboratoire d'Histocompatibilité, Etablissement Français du Sang, Lyon, France
| | - Maud Rabeyrin
- Laboratoire d'anatomopathologie, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Lionel Couzi
- Service de Néphrologie Transplantation Dialyse, Université de Bordeaux, Bordeaux, France
| | - Brigitte McGregor
- Laboratoire d'anatomopathologie, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Lionel Badet
- Unité de Formation et de Recherche Lyon Est, Université de Lyon, Lyon, France; Service d'Urologie et Transplantation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Jean Yves Scoazec
- Unité de Formation et de Recherche Lyon Est, Université de Lyon, Lyon, France; Laboratoire d'anatomopathologie, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Thomas Bachelet
- Service de Néphrologie Transplantation Dialyse, Université de Bordeaux, Bordeaux, France
| | | | - Jonathan Visentin
- Laboratoire d'immunologie et immunogénétique, Centre Hospitalier Universitaire, Hôpital Pellegrin, Bordeaux, France
| | - Pierre Merville
- Service de Néphrologie Transplantation Dialyse, Université de Bordeaux, Bordeaux, France
| | - Véronique Fremeaux-Bacchi
- Service d'Immunologie Biologique, Assistance Publique-Hopitaux de Paris, Hopital Europeen Georges Pompidou, Paris, France; and Centre de Recherche des Cordeliers, Paris, France
| | - Emmanuel Morelon
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie Clinique, Lyon, France; Institut National de la Santé et de la Recherche Médicale U1111, Lyon, France; Unité de Formation et de Recherche Lyon Est, Université de Lyon, Lyon, France
| | - Jean-Luc Taupin
- Laboratoire d'immunologie et immunogénétique, Centre Hospitalier Universitaire, Hôpital Pellegrin, Bordeaux, France
| | - Valérie Dubois
- Laboratoire d'Histocompatibilité, Etablissement Français du Sang, Lyon, France
| | - Olivier Thaunat
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie Clinique, Lyon, France; Institut National de la Santé et de la Recherche Médicale U1111, Lyon, France; Unité de Formation et de Recherche Lyon Est, Université de Lyon, Lyon, France;
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29
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Banasik M, Boratyńska M, Kościelska-Kasprzak K, Kamińska D, Bartoszek D, Żabińska M, Myszka M, Zmonarski S, Protasiewicz M, Nowakowska B, Hałoń A, Chudoba P, Klinger M. The influence of non-HLA antibodies directed against angiotensin II type 1 receptor (AT1R) on early renal transplant outcomes. Transpl Int 2014; 27:1029-38. [DOI: 10.1111/tri.12371] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 01/24/2014] [Accepted: 06/02/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Mirosław Banasik
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Maria Boratyńska
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | | | - Dorota Kamińska
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Dorota Bartoszek
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Marcelina Żabińska
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Marta Myszka
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Sławomir Zmonarski
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | | | - Beata Nowakowska
- Institute of Immunology and Experimental Therapy; Polish Academy of Science; Wroclaw Poland
| | - Agnieszka Hałoń
- Department of Pathomorphology and Oncological Cytology; Wroclaw Medical University; Wroclaw Poland
| | - Pawel Chudoba
- Department of Vascular, General and Transplantation Surgery; Wroclaw Medical University; Wroclaw Poland
| | - Marian Klinger
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
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Antibody-mediated graft injury: complement-dependent and complement-independent mechanisms. Curr Opin Organ Transplant 2014; 19:33-40. [PMID: 24316758 DOI: 10.1097/mot.0000000000000040] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Antibody-mediated rejection (AMR) is emerging as the leading cause of chronic rejection and allograft failure. Traditionally, the mechanisms of graft injury mediated by donor-specific antibodies beyond complement activation were not well appreciated. However, an evolving paradigm of Fc-independent antibody functions, along with clinical recognition of C4d-negative AMR, has increased awareness of the action of antibodies leading to endothelial activation and dysfunction. RECENT FINDINGS Herein, we address current clinical trends, including the signature of microvascular inflammation in biopsies of grafts undergoing AMR, the prevalence of antibodies to human leukocyte antigen class II DQ locus (HLA-DQ) and non-HLA targets, and the functional characterization of HLA immunoglobulin G (IgG) subclasses and complement-fixing capacity. We also discuss recent experimental evidence revealing new mechanisms of endothelial and smooth muscle cell activation by HLA antibodies, which may contribute to vascular inflammation and chronic rejection. Finally, we touch upon novel discoveries of the interplay between antibodies, the complement system, and CD4 T-cell-mediated alloimmunity. SUMMARY The current literature suggests that, although complement-fixing antibodies may have some prognostic value for graft outcome, complement-independent mechanisms of graft injury are increasingly relevant. Therapeutic strategies, which target endothelial activation induced by antibodies may ameliorate vascular inflammation and mononuclear cell infiltration characteristic of AMR.
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31
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Kikić Ž, Kozakowski N, Regele H, Priessner K, Nordmeyer V, Marinova L, Zlabinger GJ, Wahrmann M, Bartel G, Böhmig GA. Clinicopathological relevance of granular C4d deposition in peritubular capillaries of kidney allografts. Transpl Int 2014; 27:312-21. [DOI: 10.1111/tri.12254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/06/2013] [Accepted: 11/27/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Željko Kikić
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University Vienna; Vienna Austria
| | - Nicolas Kozakowski
- Clinical Institute of Pathology; Medical University Vienna; Vienna Austria
| | - Heinz Regele
- Clinical Institute of Pathology; Medical University Vienna; Vienna Austria
- Institute of Clinical Pathology; Medical University Innsbruck; Innsbruck Austria
| | - Karin Priessner
- Clinical Institute of Pathology; Medical University Vienna; Vienna Austria
| | - Veit Nordmeyer
- Clinical Institute of Pathology; Medical University Vienna; Vienna Austria
| | - Lena Marinova
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University Vienna; Vienna Austria
| | | | - Markus Wahrmann
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University Vienna; Vienna Austria
| | - Gregor Bartel
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University Vienna; Vienna Austria
| | - Georg A. Böhmig
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University Vienna; Vienna Austria
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Crespo M, Torio A, Mas V, Redondo D, Pérez-Sáez MJ, Mir M, Faura A, Guerra R, Montes-Ares O, Checa MD, Pascual J. Clinical relevance of pretransplant anti-HLA donor-specific antibodies: Does C1q-fixation matter? Transpl Immunol 2013; 29:28-33. [DOI: 10.1016/j.trim.2013.07.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/20/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
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Arnold ML, Ntokou IS, Doxiadis II, Spriewald BM, Boletis JN, Iniotaki AG. Donor-specific HLA antibodies: evaluating the risk for graft loss in renal transplant recipients with isotype switch from complement fixing IgG1/IgG3 to noncomplement fixing IgG2/IgG4 anti-HLA alloantibodies. Transpl Int 2013; 27:253-61. [DOI: 10.1111/tri.12206] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/13/2013] [Accepted: 10/02/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Marie-Luise Arnold
- Department of Internal Medicine 3; Institute for Clinical Immunology; University of Erlangen-Nürnberg; Erlangen Germany
| | - Irma-Sofia Ntokou
- National Tissue Typing Center; General State Hospital of Athens ″G.Gennimatas˝; Athens Greece
| | - Ilias I.N. Doxiadis
- Eurotransplant Reference Laboratory; Leiden University Medical Center; Leiden The Netherlands
| | - Bernd M. Spriewald
- Department of Internal Medicine 5, Hematology and Oncology; University Erlangen-Nürnberg; Erlangen Germany
| | - John N. Boletis
- Nephrology Department and Transplantation Unit; Laikon Hospital; Athens Greece
| | - Aliki G. Iniotaki
- National Tissue Typing Center; General State Hospital of Athens ″G.Gennimatas˝; Athens Greece
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Dragun D, Hegner B. Detection of C4d-fixing HLA antibodies in serum - a glass half full and half empty. Transpl Int 2013; 26:119-20. [PMID: 23317108 DOI: 10.1111/tri.12045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 11/26/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Duska Dragun
- Clinic for Nephrology and Intensive Care Medicine, Charité University Hospital, Berlin, Germany.
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Anand J, R Mallidi H. The state of the art in heart transplantation. Semin Thorac Cardiovasc Surg 2013; 25:64-9. [PMID: 23800530 DOI: 10.1053/j.semtcvs.2013.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2013] [Indexed: 11/11/2022]
Abstract
Cardiac transplantation is in its fourth decade as a treatment for end-stage cardiomyopathy and heart failure. It has reached a mature stage in its development as an effective treatment and many issues are settled with respect to best practices. However, there are many areas of ongoing research and significant advances that are continually being recognized. What constitutes 'State of the Art' in heart transplantation? This review focuses on developments in the pretransplant, peritransplant, and posttransplant phases of the care of the potential heart transplant recipient.
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Affiliation(s)
- Jatin Anand
- Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
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