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47-OR: RENAL SURVEILLANCE PROTOCOL BIOPSY WITH DONOR SPECIFIC ANTIBODY POST-TRANSPLANT
Abstract   Open access   Peer reviewed

47-OR: RENAL SURVEILLANCE PROTOCOL BIOPSY WITH DONOR SPECIFIC ANTIBODY POST-TRANSPLANT

Robert F. McAlack, Alden Doyle, Cheryl A. Hanau, Suganthi Soundararajan, Elizabeth Tecza, Nathan Burvainis, Amando Dalisay, Allison GasiewskiI and Michael Panos
Human immunology, v 73, pp 39-39
Oct 2012
DOI: https://doi.org/10.1016/j.humimm.2012.07.079
url
https://doi.org/10.1016/j.humimm.2012.07.079View
Published, Version of Record (VoR) Restricted

Abstract

Surveillance biopsies at specific time intervals detects pathology using histological criteria to aid in treatment of renal subclinical rejection which is histologically characterized by tubulointerstitial mononuclear infiltration without functional deterioration. Alternatively clinical acute rejection is characterized by functional renal impairment. Subclinical rejection can be acute cell-mediated rejection (ACR) and/or antibody-mediated rejection (AMR). A neutrophilic infiltrate and peritubular capillary deposition of complement C4d with serological evidence of donor-specific antibody (DSA) are consistent with AMR. Treatment of patients with AMR aims at depleting circulating (DSA) with IVIg, plasmapheresis or reducing antibody by eliminating CD20-positive plasma cells with monoclonal antibody. The surveillance protocol included all renal transplants for one year for a total of 33 patients. All were from deceased donors. The protocol timing is at implantation, 1,2,3 and 12 months post-implantation. These are sent for histology on ice. Results were diagnostic and reflect subclinical immunoreactivity or non-immune activity. All biopsies are assayed for C4d and DSA in serum taken at the time of biopsy. Of 33 patients transplanted, 6 showed subclinical rejection, 4 with AMR diagnosed by histology and DSA. All were treated for humoral rejection with good outcomes in 3 of the cases; the fourth developed chronic rejection with transplant glomerulopathy due to non-compliance. Three of 4 demonstrated C4d staining. This study put more importance on DSA, followed sequentially, than C4d. The DSA was interpreted as due to immune recognition- an important step but not rejection itself. Patients with DSA and evidence of hemorrhage, vasculitis, peritubular capillaritis, and transplant glomulopathy were treated for humoral rejection. Early detection and treatment of subclinical rejection reduces chronic allograft nephropathy and increases graft survival.

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Immunology
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