Hyperacute rejection of living related kidney grafts caused by endothelial cell-specific antibodies: Case reports
ABSTRACT We describe two cases of hyperacute humoral rejection of living related kidney grafts despite negative pretransplantation T- and B-lymphocyte flow cytometric crossmatches and blood group identity. Retrospectively, antiendothelial IgG antibodies were detected on a panel of umbilical cord cells in the first case, and IgM antibodies against donor endothelial precursor cells were detected using a new endothelial cell crossmatch kit in the second case. Standard crossmatch methods using donor lymphocytes failed to detect these pathogenic antibodies and did not predict the danger of hyperacute rejection.
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ABSTRACT: Severe Acute Hepatitis is a disease that causes rapid development of liver failure with coagulopathy and encephalopathy. Due to the irreversibility of this condition, the majority of cases should be treated with liver transplantation. However, it is difficult to obtain liver grafts due to the shortage of cadaveric donors and the need for urgent transplantation. An innovative therapy is being used in these cases: Auxiliary Partial Orthotopic Liver Transplantation. This technique consists of resection of the part affected of the liver and to transplant a partial graft allowing the original liver to recovery and a gradual withdrawal of immunosuppression. Material and Methods: A literature review of articles in the Medline-mesh platform with the terms “fulminant hepatitis”, “acute liver failure”, “liver transplantation” and “auxiliary partial orthotopic liver transplantation” plus governmental and official sites to obtain data of epidemiological studies. Results: This technique was recently described with good patient survival rates and it has not been performed in Brazil. Among the advantages are the suspension of immunosuppressive therapy due to the recovery of the original liver and reducing its side effects, and also posing the option of using grafts from living donors. Conclusion: Auxiliary Partial Orthotopic Liver Transplantation is a feasible treatment as shown in international transplant centers. It must be done by properly trained and skilled teams and it will represent an evolution in the liver transplantation in Brazil.
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ABSTRACT: Given the finite graft life expectancy of HLA identical organ transplants and the recognition of humoral graft injury in the absence of donor directed anti-HLA antibodies, the clinical impact of antibodies against non-HLA (nHLA) antigens in transplant injury is being increasingly recognized. The recognition of the impact of nHLA antigen discrepancies between donor and recipient on transplant outcomes is timely given the advances in rapid and lower cost sequencing methods that can soon provide complete maps of all recipient and donor HLA and nHLA mismatch data. In this review, we present a summary of recent reports evaluating the role of nHLA antibodies and their relevance to the field of organ transplantation.Human immunology 07/2013; 74(11). DOI:10.1016/j.humimm.2013.07.001 · 2.28 Impact Factor
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ABSTRACT: The necessity of detection of other than the classical major histocompatibility complex (MHC) and MHC class I-related chain A (MICA) directed antibodies prior to organ transplantation has already been repeatedly reported. A commercial flow cytometric endothelial crossmatch (CM) using isolated peripheral blood tie-2 positive cells provides a tool to detect non-MHC antibodies in addition to antibodies directed to MHC class I and II. The vast majority of circulating tie-2 positive cells expresses HLA- DR but not the A, B blood group antigens. Tie-2 cells are circulating surrogate endothelial cells. In this retrospective study we evaluated the endothelial CM in 51 renal transplantations, 30 with ABOcompatible grafts and 21 with ABO-incompatible grafts. Fifteen of the ABO-compatible recipients (group A) developed unexplained rejection episodes (RE) while the remaining 15 had no RE (group B). Five cases of group A and none of group B had a positive tie- 2 CM before transplantation (p=0.042). A positive tie-2 crossmatchCM was also correlated with graft failure in ABO-compatible transplants (p=0.02). No significant correlation was found between a positive pre-transplant tie-2 CM and RE in the ABO-incompatible group. This study strongly suggest that a positive tie-2 CM may predict post-transplantation complications in ABO compatible grafts while negative reactions are not predictive. The test is not significantly correlated with RE in ABO-incompatible grafts possibly due to applied desensitization.Human immunology 06/2013; 74(11). DOI:10.1016/j.humimm.2013.06.003 · 2.28 Impact Factor