Specific and durable elimination of antibody to donor HLA antigens in renal-transplant patients

被引:143
作者
Zachary, AA
Montgomery, RA
Ratner, LE
Samaniego-Picota, M
Haas, M
Kopchaliiska, D
Leffell, MS
机构
[1] Johns Hopkins Univ, Sch Med, Dept Med, Immunogenet Lab, Baltimore, MD 21205 USA
[2] Johns Hopkins Univ, Sch Med, Dept Surg, Baltimore, MD 21205 USA
[3] Thomas Jefferson Univ, Dept Surg, Philadelphia, PA 19107 USA
[4] Johns Hopkins Univ, Sch Med, Dept Pathol, Baltimore, MD 21205 USA
关键词
D O I
10.1097/01.TP.0000090868.88895.E0
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Donor-specific antibody (DSA) is the major barrier to success of kidney transplants. Attempts to deal with this problem have used plasmapheresis to remove antibodies or high-dose pooled immunoglobulin (IVIg) to down-regulate DSA. However, elimination of antibodies by these methods has been limited in duration or scope. Methods. We have confirmed the presence of immunoglobulin (Ig)G antibody to one or more donor HLA antigens in 49 patients treated with alternate-day, single-volume plasmapheresis followed by low-dose cytomegalovirus (CMV) hyperimmune globulin (CMV-Ig) combined with quadruple immunosuppression. We examined the effect of the treatment protocol on antibodies to donor HLA third-p arty HLA, and nominal antigens. Results. At the end of treatment, 63% of patients had lost antibody to donor HLA, whereas only 27% had lost antibody to third-party HILA (P<0.001). More strikingly, loss of antibody to donor and third-party HLA antigens occurred in 89% and 19%, respectively, of patients followed for 2 or more months after end of treatment (P<0.0001). No elimination of antiviral antibodies tested was seen. With one exception, elimination of DSA appeared to be independent of antibody titer or specificity, the number of different antibody specificities, or whether or not the target antigen was a repeat mismatch. The. effect appears to be long lasting, with no return of DSA observed in patients followed for an average of 13 months. Conclusions. Plasmapheresis and low-dose CMV-Ig combined with traditional immunosuppression is effective in producing a specific and durable elimination of antibody to donor HILA.
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页码:1519 / 1525
页数:7
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