Kimiko Yurugi

Kyoto University, Kioto, Kyōto, Japan

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Publications (56)118.86 Total impact

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    ABSTRACT: Background Anti-cyclic citrullinated peptide antibody (aCCP) is a widely-used diagnostic marker for rheumatoid arthritis (RA). In spite of its very high specificity, it is also reported that 5 to 10% of non-RA connective tissue disease (CTD) patients are positive for aCCP [1]. It is unknown whether such aCCP-positive non-RA CTD patients may develop RA later. There are few reports that referred long term outcome of aCCP-positive CTD patients. Objectives To investigate whether aCCP-positive non-RA CTD patients finally develop RA, and to find out predictive factors of RA development. Methods Non-RA CTD patients were selected from our CTD database of Kyoto University as of December 2012. Anti-CCP was measured by the second generation ELISA kit (MESACUP-2 test CCP; MBL Inc., Japan). HLA-DRB1 allele was typed by WakFlow system and the shared epitope (SE) was defined by the HLA-DRB1 alleles shown in the reference [2]. Clinical information was obtained from the clinical records and also the questionnaire to the attending doctors. Results 842 CTD patients with aCCP information were enrolled. 58 patients had fulfilled the 1987 ACR revised criteria of RA and had been followed as overlap cases, of which 35 patients (60%) were positive for aCCP. On the other hand, out of 784 patients who had not fulfilled the RA criteria, 37 patients (4.7%) were positive for aCCP. Details are shown in the Table 1 and Figure 1. During the average follow-up period of 4.8 years, none of the 37 non-RA CTD patients except one case developed RA by fulfilling the 1987 ACR revised RA criteria. Hands and feet X-ray were taken in 27 out of the 37 non-RA CTD patients, and none of them have developed bone erosions. We compared the clinical characteristics between 36 aCCP-positive RA/CTD overlapped patients and 36 aCCP-positive non-RA CTD patients, and the former showed significantly lower rheumatoid factor (RF) positivity, lower incidence of joint symptoms, less DMARDs usage, and more glucocorticoid usage. Titer of aCCP was not significantly different between these two groups. HLA DRB1 allele was typed in 26 out of 36 non-RA CTD patients and 28 out of 36 RA/CTD overlapped patients. The number of patients possessing SE were 8 (31%) and 18 (64%), respectively, the deference of which is statistically significant (p=0.01). Conclusions From our retrospective observation of follow-up period of 4.8 years in average, only one of 37 aCCP-positive non-RA CTD fulfilled the 1987 ACR revised RA criteria, but without bone erosions. The frequency of SE was significantly different between non-RA CTD patients and RA/CTD overlapped patients, which may suggest the utility of HLA typing to predict the future RA development. Because SE bind to citrullinated antigens [3], these results may also suggest that the epitope of aCCP in non-RA CTD is not dependent on citrullination. References Disclosure of Interest None declared
    No preview · Article · Jun 2015 · Annals of the Rheumatic Diseases
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    ABSTRACT: Anti-citrullinated peptide antibody (ACPA) is an autoantibody that is highly specific to rheumatoid arthritis (RA). Strong associations have been detected between HLA-DRB1 alleles and ACPA levels in RA patients. However, the associations between particular amino acid positions in HLA-DRB1 and RA patients' ACPA levels are largely unknown. We analyzed ACPA data for a total of 4,371 Japanese ACPA(+) RA patients in whom HLA-DRB1 allele genotyping had been performed. Generalized linear regression analysis and omnibus test were carried out to determine the associations between HLA-DRB1 alleles, amino acid residues or positions and ACPA levels. HLA-DRB1*09:01 and HLA-DR15 were confirmed to be associated with ACPA levels. DRB1*08:03 and DRB1*14:06 were associated with reduced and increased ACPA levels, respectively. We detected a strong association between ACPA levels and amino acid position 74 (p=1.9x10(-51) ). The association was mainly brought by alanine residue (p=5.1x10(-51) ). After adjusting for the 74(th) position, the amino acid positions 60 and 57 were found to be associated with the ACPA level. The 74(th) and 57(th) amino acid positions were previously reported to be associated with susceptibility to ACPA(+) RA in Asians. The combination of the 74(th) and 60(th) or 57(th) amino acid residues displayed improvements in fit as the models comparable to all of the significant HLA-DRB1 alleles. The 74(th) amino acid position in HLA-DRB1 is strongly associated with the ACPA level in ACPA(+) RA as well as RA susceptibility. The mechanisms of ACPA(+) RA susceptibility and ACPA production seem to partly overlap. This article is protected by copyright. All rights reserved. © 2015 American College of Rheumatology.
    No preview · Article · Apr 2015 · Arthritis and Rheumatology
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    ABSTRACT: The shared epitope (SE) is associated with increased joint destruction in rheumatoid arthritis (RA) as well as RA susceptibility and the production of anti-citrullinated peptide antibody (ACPA). However, previous studies addressing whether the association of SE with joint destruction is independent of ACPA have reported different results in different populations. Different allelic distributions in SE may explain this ethic-heterogeneity. We aimed to assess the associations of the SE and HLA-DRB1*04:05, the most common SE allele in Japanese, on joint destruction in patients with ACPA-positive RA. A total of 861 patients with ACPA-positive RA who had not received any biological agents were recruited from three different sets. Joint destruction was assessed using the modified total Sharp score (SHS). The associations of SE, HLA-DRB1*04:05 and other SE allele group on the SHS were analyzed in a linear regression analysis. Amino acid variations associated with SHS were also analyzed. The SE was significantly associated with increased SHS (p=0.0017). Although HLA-DRB1*04:05 was significantly associated with increased SHS (p=2.7x10(-5) ), the group of other SE alleles, including HLA-DRB1*01:01, did not show an association with SHS in spite of sufficient power (p=0.67). HLA-DRB1*04:05 was associated with joint destruction in a dose-dependent manner. Analyses of amino acid associations of HLA-DRB1 revealed that serine at position of 57, recently shown its susceptibility effect on ACPA-positive RA in Asian, showed a significant association (p=5.0x10(-6) ). HLA-DRB1*04:05, characterized by the 57(th) serine, accounts for the detrimental association between the SE and SHS in Japanese RA patients with ACPA. This article is protected by copyright. All rights reserved. © 2015 American College of Rheumatology.
    Full-text · Article · Mar 2015 · Arthritis and Rheumatology
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    ABSTRACT: Background: Many pediatric patients who receive a living-donor liver transplant undergo withdrawal of immunosuppression (IS). For them, the high incidence of long-term progressive graft fibrosis is of particular concern. Methods: We conducted a cross-sectional study including 81 pediatric patients who underwent IS withdrawal after living-donor liver transplant at Kyoto University Hospital and whose serum samples and pathological data could be obtained during the analysis period. We examined the association of donor-specific anti-human leukocyte antigen (HLA) antibody (DSA) and angiotensin II type 1 receptor antibody (anti-AT1R Ab) with posttransplant graft fibrosis. Normalized mean fluorescence intensity (MFI) 5,000 or higher and anti-AT1R Ab concentrations 17 U/mL or higher were both considered high level. The patients were classified into an advanced fibrosis group (AFG) (Ishak score ≥ 3) and a control group (CG) (Ishak score ≤ 2). Results: Only one patient demonstrated DSA class I. Among those who demonstrated DSA class II, more AFG patients than CG patients demonstrated high-level mean fluorescence intensity, although the difference was not significant (64% vs. 39%; P=0.053). The incidence of high-level DSA-DRB1, however, was significantly higher in the AFG than that in the CG (40% vs. 4%; P<0.001), but there was no significant difference in DSA-DQB1 or DSA-DRB345. High-level anti-AT1R Ab was significantly more frequent in the AFG than in the CG (65% vs. 36%; P=0.02). All patients with both high-level DSA-DRB1 and high-level anti-AT1R Ab were found to have advanced fibrosis (P<0.001). Conclusion: Anti-AT1R Ab and DSA-DRB1 may be candidates as biomarkers of graft fibrosis; both HLA and non-HLA immunity may be involved in graft fibrosis after IS withdrawal.
    No preview · Article · Jun 2014 · Transplantation
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    ABSTRACT: In clinical settings, serum antibody levels serve as markers of pathology. For example, antibodies related to autoimmune diseases are among the conventional targets in laboratory tests. Simple clinical tests can improve the efficacy of laboratory practice. This study describes a single-step, wash-free technique for optically detecting antibodies in human serum through the localized surface plasmon resonance (LSPR) of gold nanoparticles. As a proof-of-concept experiment, the amount of antibiotin dissolved in human serum was measured with a LSPR-based biosensor in a wash-free manner using a conventional 96-well microtiter plate and a plate reader. For an efficient surface modification of biosensors, zwitterionic copolymer was used as a scaffold on the gold nanoparticle surface to immobilize antigen and blocking reagent. Single-step, wash-free measurement of antibiotin in human serum was successfully achieved. In addition, nonspecific responses from serum contents were significantly reduced because both the copolymer and hydrophilic antigen reagent that we employed were composed of poly(ethylene oxide) spacer. Comparative experiments of the antigen-antibody reaction in serum to that in buffered solution revealed that serum is a favorable environment for the biological reaction. In conclusion, our gold-nanoparticle-based LSPR method may provide a rapid and simple way to measure the amount of antibody in serum quantitatively in clinical practice.
    No preview · Article · Apr 2014 · Analytical and Bioanalytical Chemistry
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    ABSTRACT: Objective. Methotrexate-associated lymphoproliferative disorders (MTX-LPD) often regress spontaneously during MTX withdrawal, but the prognostic factors remain unclear. The aim of our study was to clarify the clinical, histological, and genetic factors that predict outcomes in patients with MTX-LPD. Methods. Patients with MTX-LPD diagnosed between 2000 and 2012 were analyzed retrospectively regarding their clinical course, site of biopsy, histological typing, Epstein-Barr virus (EBV) in situ hybridization and immunostaining, and HLA type. Results. Twenty-one patients, including 20 with rheumatoid arthritis (RA) and 1 with polymyositis, were analyzed. The mean dose of MTX was 6.1 mg/week and the mean duration of treatment was 71.1 months. Clinically, 5 patients were diagnosed with EBV-positive mucocutaneous ulcer (EBVMCU) and had polymorphic histological findings. The proportion of those patients successfully treated solely by withdrawal of MTX was significantly greater than that of those without EBVMCU (75% vs 7.7%, p = 0.015). The HLA-B15:11 haplotype was more frequent in patients with EBV+ RA with MTX-LPD than in healthy Japanese controls (p = 0.0079, Bonferroni’s method). EBV latency classification and HLA typing were not associated with the prognosis of MTX-LPD in our cohort. Conclusion. Our data demonstrate that patients in the EBVMCU, a specific clinical subgroup of MTX-LPD, had a better clinical outcome when MTX was withdrawn than did other patients with MTX-LPD.
    Full-text · Article · Feb 2014 · The Journal of Rheumatology
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    ABSTRACT: Antibody-mediated rejection (AMR) is difficult to diagnose after ABO-compatible or ABO-identical (ABO-C) liver transplantation. To determine whether complement component 4d (C4d) immunostaining would be useful for diagnosing AMR, we compared the results of C4d immunohistochemistry for allograft biopsy samples with assays for anti-donor antibodies performed at the time of biopsy. One hundred fourteen patients with ABO-C grafts and 29 patients with ABO-incompatible (ABO-I) grafts were included. Linear C4d endothelial staining (identifiable with a 4× objective lens) or staining seen in 50% or more of the portal tracts was considered positive. Five of the 114 patients (4%) with ABO-C grafts and 15 of the 29 patients (52%) with ABO-I grafts showed C4d positivity. In the ABO-C cases, C4d positivity in late biopsy samples (≥30 days after transplantation) was associated with stage 2 or higher fibrosis (METAVIR score; P = 0.01) and with the presence of donor-specific anti-human leukocyte antigen DR antibodies (HLA-DR DSAs) with a mean fluorescence intensity > 5000 according to the Luminex single-antigen bead assay (P = 0.04). Conversely, the presence of HLA-DR DSAs was associated with the presence of stage 2 or higher fibrosis, acute cellular rejection, and C4d positivity. During the 2-year follow-up, neither C4d positivity nor HLA-DR DSAs were related to graft loss. Among ABO-I patients, C4d positivity was not associated with allograft dysfunction or fibrosis. Only 3 of the 15 C4d-positive patients (20%) showed periportal hemorrhagic edema, which could be a histological sign of AMR in ABO-I grafts, and they were the only cases associated with elevations in anti-donor A/B antibody titers. In conclusion, C4d endothelial positivity among ABO-C patients is an uncommon event that could be associated with chronic graft damage with or without clinical AMR. C4d positivity is common among ABO-I patients and may not be associated with allograft dysfunction if alloantibody titers are not elevated. Liver Transpl 20:200-209, 2014. © 2013 AASLD.
    No preview · Article · Feb 2014 · Liver Transplantation

  • No preview · Article · Jan 2014 · Japanese Journal of Transfusion and Cell Therapy
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    ABSTRACT: Methotrexate-associated lymphoproliferative disorders (MTX-LPD) often regress spontaneously during MTX withdrawal, but the prognostic factors remain unclear. The aim of our study was to clarify the clinical, histological, and genetic factors that predict outcomes in patients with MTX-LPD. Patients with MTX-LPD diagnosed between 2000 and 2012 were analyzed retrospectively regarding their clinical course, site of biopsy, histological typing, Epstein-Barr virus (EBV) in situ hybridization and immunostaining, and HLA type. Twenty-one patients, including 20 with rheumatoid arthritis (RA) and 1 with polymyositis, were analyzed. The mean dose of MTX was 6.1 mg/week and the mean duration of treatment was 71.1 months. Clinically, 5 patients were diagnosed with EBV-positive mucocutaneous ulcer (EBVMCU) and had polymorphic histological findings. The proportion of those patients successfully treated solely by withdrawal of MTX was significantly greater than that of those without EBVMCU (75% vs 7.7%, p = 0.015). The HLA-B15:11 haplotype was more frequent in patients with EBV+ RA with MTX-LPD than in healthy Japanese controls (p = 0.0079, Bonferroni's method). EBV latency classification and HLA typing were not associated with the prognosis of MTX-LPD in our cohort. Our data demonstrate that patients in the EBVMCU, a specific clinical subgroup of MTX-LPD, had a better clinical outcome when MTX was withdrawn than did other patients with MTX-LPD.
    No preview · Article · Dec 2013 · The Journal of Rheumatology
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    ABSTRACT: Living-donor lobar lung transplantation (LDLLT) is an established therapy for patients with end-stage lung disease, but living-donor lobar lung retransplantation (re-LDLLT) is rarely reported. We previously reported a case of unilateral antibody-mediated rejection after LDLLT in the presence of newly formed donor-specific antibodies against a right-lobe donor. The same patient developed contralateral bronchiolitis obliterans, resulting in bilateral bronchiolitis obliterans, but re-LDLLT was successful. Pathological findings of the explanted lungs were consistent with the clinical course of the patient. One year after re-LDLLT, the patient is doing well without any anti-human leukocyte antigen antibodies. Four lobes from 4 different donors were transplanted in this patient. The first 2 lobes were rejected eventually, but the 2 lobes implanted later presented no signs of rejection at least for 1 year after the transplant. Herein, we report this rare case and compare the clinical course and pathological findings. This article is protected by copyright. All rights reserved.
    No preview · Article · Oct 2013 · Transplant International
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    ABSTRACT: Objective: Takayasu arteritis (TAK) is a rare autoimmune arteritis that affects large arteries. Although the association between TAK and HLA-B 52:01 is established, the other susceptibility HLA-B alleles are not fully known. We performed genetic association studies to determine independent HLA-B susceptibility alleles other than HLA-B 52:01 and to identify important amino acids of HLA-B protein in TAK susceptibility. Methods: One hundred patients with TAK and 1000 unrelated healthy controls were genotyped for HLA-B alleles in the first set, followed by a replication set containing 73 patients with TAK and 1000 controls to compare the frequencies of HLA-B alleles. Step-up logistic regression analysis was performed to identify susceptibility amino acids of HLA-B protein. Results: Strong associations of susceptibility to TAK with HLA-B 52:01 and HLA-B 67:01 were observed (P = 1.0 × 10(-16) and 9.5 × 10(-6), respectively). An independent susceptibility effect of HLA-B 67:01 from HLA-B 52:01 was also detected (P = 1.8 × 10(-7)). Amino acid residues of histidine at position 171 and phenylalanine at position 67, both of which are located in antigen binding grooves of the HLA-B protein, were associated with TAK susceptibility (P ≤ 3.8 × 10(-5)) with a significant difference from other amino acid variations (ΔAIC ≥ 9.65). Conclusion: HLA-B 67:01 is associated with TAK independently from HLA-B 52:01. Two amino acids in HLA-B protein are strongly associated with TAK susceptibility.
    Full-text · Article · Jul 2013 · Rheumatology (Oxford, England)
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    ABSTRACT: Takayasu arteritis (TAK) is an autoimmune systemic vasculitis of unknown etiology. Although previous studies have revealed that HLA-B(∗)52:01 has an effect on TAK susceptibility, no other genetic determinants have been established so far. Here, we performed genome scanning of 167 TAK cases and 663 healthy controls via Illumina Infinium Human Exome BeadChip arrays, followed by a replication study consisting of 212 TAK cases and 1,322 controls. As a result, we found that the IL12B region on chromosome 5 (rs6871626, overall p = 1.7 × 10(-13), OR = 1.75, 95% CI 1.42-2.16) and the MLX region on chromosome 17 (rs665268, overall p = 5.2 × 10(-7), OR = 1.50, 95% CI 1.28-1.76) as well as the HLA-B region (rs9263739, a proxy of HLA-B(∗)52:01, overall p = 2.8 × 10(-21), OR = 2.44, 95% CI 2.03-2.93) exhibited significant associations. A significant synergistic effect of rs6871626 and rs9263739 was found with a relative excess risk of 3.45, attributable proportion of 0.58, and synergy index of 3.24 (p ≤ 0.00028) in addition to a suggestive synergistic effect between rs665268 and rs926379 (p ≤ 0.027). We also found that rs6871626 showed a significant association with clinical manifestations of TAK, including increased risk and severity of aortic regurgitation, a representative severe complication of TAK. Detection of these susceptibility loci will provide new insights to the basic mechanisms of TAK pathogenesis. Our findings indicate that IL12B plays a fundamental role on the pathophysiology of TAK in combination with HLA-B(∗)52:01 and that common autoimmune mechanisms underlie the pathology of TAK and other autoimmune disorders such as psoriasis and inflammatory bowel diseases in which IL12B is involved as a genetic predisposing factor.
    Full-text · Article · Jul 2013 · The American Journal of Human Genetics
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    ABSTRACT: Aim: To analyze the risks of preoperatively produced donor-specific antibody (DSA) in liver transplantation. Methods: DSA was assessed using direct complement-dependent cytotoxicity (CDC) and anti-human globulin- (AHG-) CDC tests, as well as the Luminex Single Antigen assay. Among 616 patients undergoing blood type identical or compatible living donor liver transplantation (LDLT), 21 patients were positive for CDC or AHG-CDC tests, and the preserved serum from 18 patients was examined to determine targeted Class I and II antigens. The relationships between the mean fluorescence intensity (MFI) of DSA and the clinical outcomes were analyzed. Results: Patients were divided into 3 groups according to the MFI of anti-Class I DSA: high (11 patients with MFI > 10,000), low (2 patients with MFI < 10,000), and negative (5 patients) MFI groups. Six of 11 patients with high Class-I DSA showed positive Class-II DSA. Hospital death occurred in 7 patients of the high MFI group. High MFI was a significant risk factor for mortality (P = 0.0155). Univariate analysis showed a significant correlation between MFI strength and C4d deposition (P = 0.0498). Conclusions: HLA Class I DSA with MFI > 10,000 had a significant negative effect on the clinical outcome of patients with preformed DSA in LDLT.
    Full-text · Article · May 2013 · Clinical and Developmental Immunology
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    ABSTRACT: Recently, the importance of anti-human leukocyte antigen (HLA) antibodies has been pointed out in kidney and liver transplantation. In 2010, Hachem et al. reported the association of donor-specific anti-HLA antibodies (DSA) with acute and chronic rejection in lung transplantation. We investigated the appearance and the trend of anti-HLA antibodies in living-donor lobar lung transplantation (LDLLT) and cadaveric lung transplantation (CLT) at a single lung transplant center in Japan.Methods and MaterialsWe performed 30 cases of LDLLT and 21 cases of CLT at Kyoto University between June 2008 and October 2012. Since July 2010, anti-HLA antibodies had been screened periodically, using LABScreen Mixed (One Lambda, CA, USA). In addition, they were also investigated when recipients presented symptoms or abnormal findings. When anti-HLA antibodies were detected, their specificities were identified using LABScreen Single Antigen (One Lambda, CA, USA).ResultsAnti-HLA antibodies were measured 3.6 ± 2.0 times in 27 cases of LDLLT and 20 cases of CLT. Anit-HLA antibodies were detected in 4 cases in LDLLT (14%) and 5 cases in CLT (25%). Among them, 2 cases in LDLLT (7%) and 2 cases in CLT (10%) had DSA. In LDLLT, one patient had re-LDLLT because of bilateral bronchiolitis obliterans after ipsilateral antibody-mediated rejection. In other 3 patients, class I and/or class II DSA were detected 2 weeks, 1 month, and 10 months after transplantation. All of them were treated with intravenous immunoglobulin and showed no sign of antibody-mediated rejection in a close follow-up.Conclusions In comparison with the current report by Hachem et al., the frequency of DSA appearance was relatively low in our institution. However, DSA was detected even in the early phase of posttransplant days. Accumulation of more cases and longer follow-up were necessary.
    No preview · Article · Apr 2013 · The Journal of Heart and Lung Transplantation

  • No preview · Article · Jan 2013 · Japanese Journal of Transfusion and Cell Therapy

  • No preview · Article · Jan 2013 · Japanese Journal of Transfusion and Cell Therapy
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    ABSTRACT: Purpose: Living-donor lobar lung transplantation (LDLLT) has been successfully performed in Japan. In LDLLT, the recipient usually receives one lower lobe from each of two donors; however, finding two ABO-matched donors is often difficult. Solid organ transplants from donors with minor ABO-mismatches can be complicated by hemolysis. We investigated the incidence of de novo anti-ABO antibody production and hemolysis in patients receiving LDLLT across minor ABO-mismatches. Methods: We evaluated 23 patients who underwent LDLLT between June 2008 and December 2011, including 11 patients who underwent minor ABO-mismatched transplantation. We measured the anti-A/B antibody serum titers, hemoglobin concentrations and indirect bilirubin levels. Results: None of the patients showed any clinical signs of hemolytic anemia (mean follow-up period; 16 months). Two of the 11 patients (18 %) receiving minor ABO-mismatched LDLLTs showed a small amount of de novo anti-B antibodies for a transient period. These patients showed gradual progression of anemia, and weak de novo anti-A/B antibodies were detected with column agglutination technology. The patients received only 2 U of washed type O red blood cells; thereafter, the hemolytic anemia did not develop further in either case. Conclusion: LDLLT across minor ABO-mismatches results in the transient appearance of weak de novo anti-A/B antibodies with a low incidence; thus, this procedure can be a safe treatment.
    No preview · Article · Nov 2012 · Surgery Today

  • No preview · Article · Nov 2012 · Transplantation
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    ABSTRACT: The role of donor‐specific anti‐human leukocyte antigen antibodies (DSAs) that develop late after living donor liver transplantation is unknown. Seventy‐nine pediatric recipients who had good graft function and underwent protocol liver biopsy more than 5 years after transplantation (median = 11 years, range = 5‐20 years) were reviewed. DSAs were determined with the Luminex single‐antigen bead assay at the time of the last biopsy, and complement component 4d (C4d) immunostaining was assessed at the times of the last biopsy and the previous biopsy. The donor specificity of antibodies could be identified in 67 patients: DSAs were detected in 32 patients (48%), and they were usually against human leukocyte antigen class II (30 cases) but were rarely against class I (2 cases). These patients had a higher frequency of bridging fibrosis or cirrhosis (28/32 or 88%) than DSA‐negative patients (6/35 or 17%, P P P = 0.004]. Four DSA‐negative patients were off immunosuppression, whereas no patients in the DSA‐positive group were (P = 0.048). In conclusion, the high prevalence of graft fibrosis and anti–class II DSAs in late protocol biopsy samples suggests that humoral alloreactivity may contribute to the process of unexplained graft fibrosis late after liver transplantation. Liver Transpl 18:1333–1342, 2012. © 2012 AASLD.
    Full-text · Article · Nov 2012 · Liver Transplantation
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    Dataset: Table S6
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    ABSTRACT: Comparison between ACPA-positive RF-positive RA and ACPA-positive RF-negative RA. a) Alleles with frequency more than 1% in any groups are shown. (DOC)
    Preview · Dataset · Jul 2012

Publication Stats

331 Citations
118.86 Total Impact Points

Institutions

  • 2010-2013
    • Kyoto University
      • Department of Transfusion Medicine and Cell Therapy
      Kioto, Kyōto, Japan
  • 2012
    • Kyōto Medical Center
      Kioto, Kyōto, Japan
  • 2005-2007
    • Kyoto Prefectural University of Medicine
      • Department of Nursing
      Kioto, Kyoto, Japan