Effects of recombinant human erythropoietin on HLA sensitization and cell mediated immunity.

Abstract:

:Highly presensitized patients wait longer for a renal allograft than unsensitized patients and have a poorer allograft survival rate. Repeated blood transfusions have been implicated in the induction and maintenance of sensitization. To determine the effect of recombinant human erythropoietin (rHuEPO) therapy on five transfusion dependent, highly sensitized adolescents on dialysis, we serially measured percentage panel reactive antibody (%PRA) levels, titers of identifiable discrete anti-HLA Class I antibody specificities, and non-specific indices of cellular immunity before and following initiation of rHuEPO therapy. Although four of the five patients had previously rejected at least one renal allograft, the removal of chronic antigenic stimulation from blood transfusions led to a marked reduction in anti-HLA antibody titers to recognizable private and public specificities (P less than 0.001) and a reduction of mean %PRA from 80% to 56% (P less than 0.05). Each patient demonstrated a reduction of two or more dilutions to at least two anti-HLA antibody specificities. A control group of five patients matched for age, transfusion dependence and sensitization status demonstrated no change during a comparable time interval. PHA responsiveness decreased significantly in the rHuEPO group whereas autologous and allogenic mixed lymphocyte response, spontaneous blastogenesis and T-cell subsets did not. These data indicate that in highly sensitized dialysis patients rHuEPO may lead to decreased sensitization, shorter waiting time on dialysis and possibly improved allograft survival rates.

journal_name

Kidney Int

journal_title

Kidney international

authors

Grimm PC,Sinai-Trieman L,Sekiya NM,Robertson LS,Robinson BJ,Fine RN,Ettenger RB

doi

10.1038/ki.1990.161

subject

Has Abstract

pub_date

1990-07-01 00:00:00

pages

12-8

issue

1

eissn

0085-2538

issn

1523-1755

pii

S0085-2538(15)34923-1

journal_volume

38

pub_type

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