title: Allosensitization of islet allograft recipients.
abstract: BACKGROUND
  The immune monitoring of islet transplant recipients includes the assessment of panel reactive antibodies (PRA). A negative association of PRA+ with allogeneic solid organ graft survival has been recognized, but scattered data is available for islet transplantation.
  
  
  METHODS
  We performed a retrospective analysis of PRA status in 66 patients with type 1 diabetes mellitus recipient of islet allografts between 1985 and 2006.
  
  
  RESULTS
  Pretransplant PRA+ was observed in 10 subjects in the old trials and associated with kidney transplantation and/or pregnancies. Thirteen subjects displayed PRA+ at follow-up, eight of whom were de novo. Overall, PRA+ did not correlate with islet graft outcome: long-term graft survival was observed in the presence of basal or persistent PRA+ and graft dysfunction occurred also in the absence of PRA+. Loss of graft function was associated with PRA+ after lowering of immunosuppression or after infection episodes. Loss of C-peptide did not affect kidney graft function even in simultaneous islet-kidney transplant recipients. Mostly, PRA remained negative under adequate immunosuppression. Patients whose immunosuppression was discontinued invariably developed PRA+.
  
  
  CONCLUSIONS
  Monitoring of PRA under immunosuppression may have little clinical value under adequate immunosuppression in islet transplant recipients. The implications of allosensitization after discontinuation of immunosuppression need to be evaluated to define the real clinical impact in this patient population.
authors: Clinical Islet Transplant Program, Cell Transplant Center, Diabetes Research Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
authors: Roberta
authors: R
authors: Cardani
authors: Antonello
authors: A
authors: Pileggi
authors: Camillo
authors: C
authors: Ricordi
authors: Carmen
authors: C
authors: Gomez
authors: David A
authors: DA
authors: Baidal
authors: Gaston G
authors: GG
authors: Ponte
authors: Davide
authors: D
authors: Mineo
authors: Raquel N
authors: RN
authors: Faradji
authors: Tatiana
authors: T
authors: Froud
authors: Gaetano
authors: G
authors: Ciancio
authors: Violet
authors: V
authors: Esquenazi
authors: George W
authors: GW
authors: Burke
authors: Gennaro
authors: G
authors: Selvaggi
authors: Joshua
authors: J
authors: Miller
authors: Norma S
authors: NS
authors: Kenyon
authors: Rodolfo
authors: R
authors: Alejandro
mesh_terms: D000328:Adult; D000368:Aged; D000906:Antibodies / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology; D006649:Histocompatibility Antigens / Q000276:immunology; D006801:Humans; D007164:Immunosorbents / Q000494:pharmacology; D016381:Islets of Langerhans Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D006649:Histocompatibility Antigens; D007164:Immunosorbents