Subclinical Antibody-mediated Rejection After Kidney Transplantation: Treatment Outcomes.


BACKGROUND:Antibody-mediated rejection (AMR) is a leading cause of morbidity and mortality after kidney transplantation. Early diagnosis and treatment of subclinical AMR based on the donor-specific antibody (DSA) testing may result in better outcomes. METHODS:We tested this hypothesis in 220 kidney transplant recipients who underwent an indication or DSA-based surveillance protocol biopsies between March 1, 2013 and December 31, 2016. Patients were divided into 3 groups: clinical AMR (n = 118), subclinical AMR (n = 25), or no rejection on protocol biopsy (controls; n = 77). RESULTS:Both clinical and subclinical AMR groups underwent similar treatment including plasmapheresis, pulse steroids, IVIG, and rituximab (P = ns). Mean follow-up after AMR was 29.5 ± 16.8 months. There were 2 (3%), 2 (8%), and 54 (46%) death-censored graft failures in the control, subclinical, and clinical AMR groups, respectively (P < 0.001). Graft outcomes were similar in the subclinical rejection and control groups. In adjusted Cox regression analysis, only clinical rejection (hazards ratio [HR], 4.31; 95% confidence interval [CI], 1.01-18.94; P = 0.05) and sum chronicity scores (HR, 1.16; 95% CI, 1.01-1.35; P = 0.03) were associated with increased risk of graft failure, while estimated glomerular filtration rate at time of biopsy (HR, 0.98; 95% CI, 0.96-0.99; P = 0.01) was associated with decreased risk of graft failure. CONCLUSIONS:Our study suggests that early diagnosis and treatment of subclinical AMR using DSA monitoring may improve outcomes after kidney transplantation.






Parajuli S,Joachim E,Alagusundaramoorthy S,Blazel J,Aziz F,Garg N,Muth B,Mohamed M,Mandelbrot D,Zhong W,Djamali A




Has Abstract


2019-08-01 00:00:00












  • Inability of isolated soluble interleukin-2 receptor levels to predict biopsy rejection scores after heart transplantation.

    abstract::Successful cardiac transplantation requires suppression of rejection, and endomyocardial biopsy is generally used to quantify this and guide immunotherapy. Biopsy, however, is an invasive, costly, cardiac catheterization with repetition limited. Since rejection requires lymphocyte activation, an alternative method of ...


    pub_type: 杂志文章


    authors: Young JB,Windsor NT,Smart FW,Kleiman NS,Weilbaecher DG,Noon GP,Nelson DL,Lawrence EC

    更新日期:1991-03-01 00:00:00

  • Increased expression of endoarterial vascular cell adhesion molecule-1 mRNA in an experimental model of lung transplant rejection: diagnosis by pulmonary arterial biopsy.

    abstract:BACKGROUND:Early detection of rejection after lung transplantation may prevent allograft failure. This study determines if mRNA from the cell adhesion molecules intercellular adhesion molecule-1, vascular cell adhesion molecule (VCAM)-1, and E-selectin in pulmonary endovascular tissue samples could be markers of early ...


    pub_type: 杂志文章


    authors: Rothman A,Mann D,Behling CA,McGraw M,Seslar S,Shiu P,Zhang L,Kriett JM

    更新日期:2003-04-15 00:00:00

  • Mycobacterium haemophilum infections in bone marrow transplant recipients.

    abstract::The purpose of this study was to describe the clinical presentation, treatment, and outcome of Mycobacterium haemophilum infection in patients undergoing bone marrow transplantation at a cancer center. Bone marrow transplant recipients with M haemophilum infection were identified upon culture of the organism by implem...


    pub_type: 杂志文章


    authors: White MH,Papadopoulos EB,Small TN,Kiehn TE,Armstrong D

    更新日期:1995-11-15 00:00:00

  • Novel Therapeutic Approaches to Allosensitization and Antibody-mediated Rejection.

    abstract::Modification of pathogenic antibodies for autoimmune diseases illuminated the biologic relevance of B cells, plasma cells, and pathogenic antibodies in autoimmunity. They have also rejuvenated interest in how B cells mediate multiple effector functions that include antibody production, antigen presentation to T cells,...


    pub_type: 杂志文章,评审


    authors: Jordan SC,Ammerman N,Choi J,Huang E,Peng A,Sethi S,Najjar R,Toyoda M,Lim K,Louie S,Vo A

    更新日期:2019-02-01 00:00:00

  • Reduced dose rabbit anti-thymocyte globulin induction for prevention of acute rejection in high-risk kidney transplant recipients.

    abstract:BACKGROUND:Despite the prevalent use of rabbit antithymocyte globulin (rATG) as an induction agent in kidney transplantation, the appropriate dose for preventing acute rejection in high-risk patients is not known. Few studies have examined total exposure of rATG less than 6 mg/kg, with fewer studies examining lower dos...


    pub_type: 杂志文章


    authors: Klem P,Cooper JE,Weiss AS,Gralla J,Owen P,Chan L,Wiseman AC

    更新日期:2009-10-15 00:00:00

  • Long-term regeneration of human epidermis on third degree burns transplanted with autologous cultured epithelium grown on a fibrin matrix.

    abstract:BACKGROUND:Extensive third degree burn wounds can be permanently covered by the transplantation of autologous cultured keratinocytes. Many modifications to Green and colleagues' original technique have been suggested, including the use of a fibrin matrix. However, the properties of the cultured cells must be assessed u...


    pub_type: 杂志文章


    authors: Ronfard V,Rives JM,Neveux Y,Carsin H,Barrandon Y

    更新日期:2000-12-15 00:00:00

  • Effect of renal allograft dysfunction upon cyclosporine trough levels in host blood.

    abstract::Cyclosporine (CsA) dose adjustment after renal transplantation is generally based on serum, plasma, or whole-blood trough level values. In the face of increased levels, the dosage is reduced in order to prevent CsA-induced nephrotoxicity. There is a paucity of data, however, on the kinetics of CsA in association with ...


    pub_type: 杂志文章


    authors: Arnold AN,Waltzer WC,Anaise D,Weinstein SW,Rapaport FT

    更新日期:1985-12-01 00:00:00

  • Evidence that portal tract microvascular destruction precedes bile duct loss in human liver allograft rejection.

    abstract::In liver allograft rejection, interlobular bile ducts are thought to be the main target of rejection. In contrast, in other organ allografts the capillary bed of the graft appears to be the primary target. To determine whether portal tract microvasculature is destroyed in liver allografts during rejection, we have ide...


    pub_type: 杂志文章


    authors: Matsumoto Y,McCaughan GW,Painter DM,Bishop GA

    更新日期:1993-07-01 00:00:00

  • Rapid development of subacute myelopathy in three organ transplant recipients after transmission of human T-cell lymphotropic virus type I from a single donor.

    abstract:BACKGROUND:Human T-cell lymphotropic virus type I (HTLV-I) causes a subacute myelopathy in less than 5% of chronic carriers. However, the risk of neurologic disease appears to increase in persons infected through blood transfusion. METHODS:We report three recipients of solid organ transplants who developed a subacute ...


    pub_type: 评论,杂志文章


    authors: Toro C,Rodés B,Poveda E,Soriano V

    更新日期:2003-01-15 00:00:00

  • Donor bone marrow potentiates the effect of tacrolimus on nonvascularized heart allograft survival: association with microchimerism and growth of donor dendritic cell progenitors from recipient bone marrow.

    abstract:BACKGROUND:The influence of donor hematopoietic cell microchimerism on organ allograft survival has been studied largely in vascularized transplant models. Here, we examine the impact of donor bone marrow (BM) cells administered intravenously together with transient systemic tacrolimus therapy on microchimerism, the su...


    pub_type: 杂志文章


    authors: Khanna A,Steptoe RJ,Antonysamy MA,Li W,Thomson AW

    更新日期:1998-02-27 00:00:00

  • Combined liver-intestine grafts compared with isolated intestinal transplantation in children: a single-center experience.

    abstract:BACKGROUND:Intestinal transplantation is known to be associated with a high risk of early complications and mortality. METHODS:We analyzed prospective data of 51 primary small bowel transplantations from December 1999 to August 2009 and identified perioperative factors that impact on early mortality (≤6 months after t...


    pub_type: 杂志文章


    authors: Dopazo C,Gupte GL,Sharif K,Perera MT,Hartley J,Muiesan P,Mayer DA,Bromley P,Bennett J,Kelly DA,van Mourik I,McKiernan P,Beath SV,Mirza DF

    更新日期:2012-10-27 00:00:00

  • Evaluation and clinical significance of circulating immune complexes after renal transplantation.

    abstract::Using C1q binding, Kg binding, and Raji cell radioimmunoassays, the relationship between renal allograft rejection and the circulating immune complexes was examined in 90 patients with renal transplants. The data showed that there was a significant quantitative correlation between C1q-binding and Raji-cell-binding act...


    pub_type: 杂志文章


    authors: Fukuda M

    更新日期:1983-08-01 00:00:00

  • mTOR Inhibition Role in Cellular Mechanisms.

    abstract::The mammalian target of rapamycin inhibitors (mTOR-I), drugs widely used in transplant medicine and oncology, exert their function by inhibiting a serine/threonine kinase with a pivotal role in cellular metabolism and in a wide range of eukaryotic biological/cellular functions and signaling networks. Additionally, as ...


    pub_type: 杂志文章,评审


    authors: Zaza G,Granata S,Caletti C,Signorini L,Stallone G,Lupo A

    更新日期:2018-02-01 00:00:00

  • Pattern of liver, kidney, heart, and intestine allograft rejection in different mouse strain combinations.

    abstract::With advances in microsurgery and molecular biology, the mouse model for organ transplantation has become increasingly popular. However, knowledge about these models is limited, as only a small number of centers have experience with murine models. In this study, we compared the rejection pattern after liver, kidney, h...


    pub_type: 杂志文章


    authors: Zhang Z,Zhu L,Quan D,Garcia B,Ozcay N,Duff J,Stiller C,Lazarovits A,Grant D,Zhong R

    更新日期:1996-11-15 00:00:00

  • Lethal post-transplantation calcinosis.

    abstract::The case studies of four patients with post-transplantation calcinosis are presented. Three of the four patients died of inanition and sepsis secondary to infection of extensive soft tissue ulcers and diffuse cutaneous vascular calcification with gangrene. The fourth patient survived following removal of all four para...


    pub_type: 杂志文章


    authors: Perloff LJ,Spence RK,Grossman RA,Barker CF

    更新日期:1979-01-01 00:00:00

  • Effect of core pancreas temperature during cadaveric procurement on human islet isolation and functional viability.

    abstract:BACKGROUND:Success of human pancreatic islet isolation depends largely on the techniques used during pancreas procurement and the quality of the gland. Warm ischemia of the pancreas of any duration during organ procurement may be detrimental to subsequent islet yield and functional viability of the islets. The aim of t...


    pub_type: 杂志文章


    authors: Lakey JR,Kneteman NM,Rajotte RV,Wu DC,Bigam D,Shapiro AM

    更新日期:2002-04-15 00:00:00

  • Transesophageal echocardiography during orthotopic liver transplantation in patients with esophagoastric varices.

    abstract:BACKGROUND:Hemodynamic monitoring using transesophageal echocardiography (TEE) in patients with signs of portal hypertension undergoing orthotopic liver transplantation (OLT) carries potential risk of esophageal and gastric variceal hemorrhage. The aim of our retrospective analysis was to evaluate the safety of intraop...


    pub_type: 杂志文章


    authors: Burger-Klepp U,Karatosic R,Thum M,Schwarzer R,Fuhrmann V,Hetz H,Bacher A,Berlakovich G,Krenn CG,Faybik P

    更新日期:2012-07-27 00:00:00

  • Tacrolimus (FK506) and cyclosporine reduce the uptake and transport of particles into rabbit Peyer's patches.

    abstract::Tacrolimus (FK) and cyclosporine (Cs) are potent immunosuppressants that effectively prevent the rejection of transplanted organs including liver and small intestine. Our study examined the effects of these immunosuppressants on Peyer's patches, which play an important role in mucosal immune response through uptake an...


    pub_type: 杂志文章


    authors: Fujimura Y,Owen RL

    更新日期:2002-04-15 00:00:00

  • Immunosuppression with FTY720 and cyclosporine A inhibits rejection of adult porcine islet xenografts in rats.

    abstract:BACKGROUND:Our aim was to evaluate the effect of FTY720 in discordant islet xenotransplantation. METHODS:Fetal porcine islet-like cell clusters (ICCs) were transplanted into normoglycemic rats that were either left untreated or treated with FTY720 only, with FTY720 plus cyclosporine A (CsA) or with CsA only. Twelve or...


    pub_type: 杂志文章


    authors: Maeda A,Goto M,Zhang J,Bennet W,Groth CG,Korsgren O,Wennberg L

    更新日期:2003-04-27 00:00:00

  • Xenogeneic skin and kidney transplants in a closely related canine system, fox-dog.

    abstract::Fox kidney and skin grafts were transplanted into dog recipients. Fox kidneys, transplanted en bloc into untreated dogs, survived 6.2 +/- 0.4 days. The skin transplants survived 5.9 +/- 1.4 days. The grafted kidneys showed almost normal function before rejection. Both skin and kidney rejection were mediated through a ...


    pub_type: 杂志文章


    authors: Chaussy C,Hammer C,von Scheel J,Pielsticker K,Sollinger HW,Pfeifer KJ,Pongratz H,Brender W

    更新日期:1975-08-01 00:00:00

  • Nosocomial Legionnaires' disease following renal transplantation.

    abstract::A cluster of five cases of Legionnaires' disease in renal transplant patients is described. They were treated with erythromycin and rifampicin, and all five survived. Two of them had rejected their grafts prior to their Legionella pneumonia; two rejected their transplants after reduction of immunosuppressive therapy t...


    pub_type: 杂志文章


    authors: Wilczek H,Kallings I,Nyström B,Hoffner S

    更新日期:1987-06-01 00:00:00

  • Utilization of Donor Kidneys With Acute Kidney Injury in Pediatric Kidney Transplant Recipients.

    abstract:BACKGROUND:An elevated terminal creatinine is frequently used as a reason for organ refusal in pediatric kidney transplantation. There is increasing evidence that adults who receive kidneys from donors with moderate to severe acute kidney injury (AKI) have similar outcomes to recipients who receive kidneys from donors ...


    pub_type: 杂志文章


    authors: Solomon S,Hayde N

    更新日期:2020-03-01 00:00:00

  • Metabolic syndrome and atherosclerotic events in renal transplant recipients.

    abstract:BACKGROUND:Metabolic syndrome (MS) is a known cardiovascular risk factor in the general population. We explored the influence of MS on the occurrence of atherosclerotic events (AEs) after renal transplantation. METHODS:Three hundred thirty-seven renal transplant recipients were included in the study. Various parameter...


    pub_type: 杂志文章


    authors: Courivaud C,Kazory A,Simula-Faivre D,Chalopin JM,Ducloux D

    更新日期:2007-06-27 00:00:00

  • Humanization of Immunodeficient Animals for the Modeling of Transplantation, Graft Versus Host Disease, and Regenerative Medicine.

    abstract::The humanization of animals is a powerful tool for the exploration of human disease pathogenesis in biomedical research, as well as for the development of therapeutic interventions with enhanced translational potential. Humanized models enable us to overcome biologic differences that exist between humans and other spe...


    pub_type: 杂志文章


    authors: Adigbli G,Ménoret S,Cross AR,Hester J,Issa F,Anegon I

    更新日期:2020-11-01 00:00:00

  • HLA-restricted cytotoxicity against male-specific (H-Y) antigen after acute rejection of an HLA-identical sibling kidney: clonal distribution of the cytotoxic cells.

    abstract::A 22-year-old previously nonsensitized female patient (HLA-A2,28; B7,14; DR1,2) received a kidney from her HLA-identical brother. She irreversibly rejected the graft 2 1/2 weeks later. In vitro tests performed 6 weeks after the graft loss, using recipient responding and donor-stimulating and target cells, revealed a w...


    pub_type: 杂志文章


    authors: Pfeffer PF,Thorsby E

    更新日期:1982-01-01 00:00:00

  • Ethics Guide Recommendations for Organ-Donation-Focused Physicians: Endorsed by the Canadian Medical Association.

    abstract::Donation physicians are specialists with expertise in organ and tissue donation and have been recognized internationally as a key contributor to improving organ and tissue donation services. Subsequent to a 2011 Canadian Critical Care Society-Canadian Blood Services consultation, the donation physician role has been g...


    pub_type: 杂志文章,实务指引


    authors: Shemie SD,Simpson C,Blackmer J,MacDonald S,Dhanani S,Torrance S,Byrne P,Donation Physician Ethics Guide Meeting Participants.

    更新日期:2017-05-01 00:00:00

  • Immune response, accommodation, and tolerance to transplantation carbohydrate antigens.

    abstract::The carbohydrate antigens, blood groups A and B, and the alpha-gal epitope (Galalpha1-3Gal) are major risk factors in transplantation. Transplantation across ABO barriers may result in rejection by elicited anti-blood group antibodies, accommodation where elicited anti-blood group antibodies do not reject the graft, o...


    pub_type: 杂志文章,评审


    authors: Galili U

    更新日期:2004-10-27 00:00:00

  • Studies on the immunosuppressive properties of cyclosporin a in rats receiving renal allografts.

    abstract::The immunosuppressive effects of cyclosporin A were tested in a DA (RT-1a) to Lewis (RT-1(1) rat renal allograft model, which represents a very strong histocompatibility barrier. Dose-response studies established that oral doses of 5 mg/kg/day or higher gave complete suppression of rejection, while oral doses of 2 mg/...


    pub_type: 杂志文章


    authors: Homan WP,Fabre JW,Williams KA,Millard PR,Morris PJ

    更新日期:1980-05-01 00:00:00

  • HLA-DR and DQ typing by polymerase chain reaction using sequence-specific primer mixes reduces the incidence of phenotypic homozygosity (blanks) over serology.

    abstract::Because of the inherent difficulties in allele assignment with HLA-DR serological typing, in 1993 our organ procurement organization-based HLA laboratory replaced serology with the molecular method of polymerase chain reaction using sequence-specific primer mixes (PCR-SSP) to type for DR and DQ at a resolution level e...


    pub_type: 杂志文章


    authors: Bryan CF,Harrell KM,Nelson PW,Pierce GE,Ross G,Shield CF 3rd,Warady BA,Aeder MI,Helling TS,Landreneau MD,Luger AM

    更新日期:1996-12-27 00:00:00

  • Association of the genetic polymorphisms of the renin-angiotensin system and endothelial nitric oxide synthase with chronic renal transplant dysfunction.

    abstract:BACKGROUND:Chronic allograft dysfunction (CAD) is a complex phenomenon caused by underlying kidney disease and superimposed environmental and genetic factors. We investigated the association of polymorphisms in the genes for angiotensin-converting enzyme (ACE), angiotensinogen (AGT), angiotensin II receptor type 1 (ATR...


    pub_type: 杂志文章


    authors: Akcay A,Sezer S,Ozdemir FN,Arat Z,Atac FB,Verdi H,Colak T,Haberal M

    更新日期:2004-09-27 00:00:00