title: A novel post-transplant alloantibody surveillance and intervention strategy that improves graft outcomes in sensitized renal transplant recipients.
abstract: Chronic rejection, the leading cause of renal graft failure, is mediated by alloantibody graft destruction. Monitoring alloantibodies posttransplant might facilitate early diagnosis of alloantibody mediated graft destruction and provide an opportunity for intervention. Herein, we describe our alloantibody surveillance and intervention protocol that has improved graft survival. Patients (n = 69) with preoperatively positive FCXM and DSA were transplanted. Patient compatibility with donors was assessed by FCXM and donor specific antibody using single antigen bead Luminex. FCXM and DSA levels were monitored quarterly posttransplant. We identified a posttransplant profile strongly associated with chronic rejection. We then implemented a point-based formula that indicated when to initiate preemptive treatment with IVIG and plasmapheresis. The results of posttransplant antibody surveillance revealed 2 profiles. Most patients (65%) showed complete elimination of FCXM reactivity and DSA levels within 12 months of transplant. Three-year graft survival exceeded 95% and patients were chronic rejection-free. In contrast, the remaining patients failed to eliminate antibody as assessed by FCXM and DSA levels. Graft survival was inferior and chronic rejection was diagnosed in 43% of the group. Subsequent inclusion of preemptive treatment using the point-based system improved 3-year graft survival from 50% to 90%. In conclusion, the data show that implementation of an evidence based antibody surveillance protocol and an intervention protocol successfully improved graft survival.
authors: Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia, USA. pkimball@gems.vcu.edu
authors: Pamela M
authors: PM
authors: Kimball
authors: Anne
authors: A
authors: King
mesh_terms: D005434:Flow Cytometry; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility / Q000187:drug effects; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D015166:Monitoring, Immunologic; D010956:Plasmapheresis; D011446:Prospective Studies; D013997:Time Factors; D023001:Transplantation Tolerance; D016896:Treatment Outcome; D014768:Virginia
chemical_list: D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D007518:Isoantibodies