A significant role for histocompatibility in human islet transplantation

被引:52
作者
Mohanakumar, T.
Narayanan, Kishore
Desai, Niraj
Ramachandran, Sabarinathan
Shenoy, Surendra
Jendrisak, Martin
Susskind, Brian M.
Olack, Barbara
Benshoff, Nicholas
Phelan, Donna L.
Brennan, Daniel C.
Fernandez, Luis A.
Odorico, Jon S.
Polonsky, Kenneth S.
机构
[1] Washington Univ, Sch Med, Dept Surg, CSRB, St Louis, MO 63110 USA
[2] Washington Univ, Sch Med, Dept Pathol, St Louis, MO 63110 USA
[3] Univ Cincinnati, Med Ctr, HLA Lab, Hoxworth Blood Ctr, Cincinnati, OH 45267 USA
[4] BJC Hosp, HLA Hosp, St Louis, MO USA
[5] Washington Univ, Sch Med, Dept Internal Med, St Louis, MO 63110 USA
[6] Univ Wisconsin, Div Transplantat, Madison, WI USA
关键词
antibody; histocompatibility; islets; transplantation;
D O I
10.1097/01.tp.0000226161.82581.b2
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. In recent years, transplantation of islets and pancreas has become a viable option for patients debilitated with type I diabetes. The success of islet transplantation has been attributed to the ability to isolate high quality islets for transplantation and capacity to maintain the recipient's immunosuppressive levels within a specific target range following transplantation. The purpose of this study was to determine the role of pretransplant sensitization to human leukocyte antigen (HLA) in islet transplantation. Methods. We retrospectively analyzed seven patients that were transplanted with islets under the auspices of the Juvenile Diabetes Research Foundation and Islet Cell Resource Center/National Institutes of Health. Humoral sensitization towards donor antigens both prior to and following islet transplantation was detected by FLOW panel reactive antibodies (PRA) and donor-specific cellular sensitization was detected by performing enzyme-linked immunospot assay analysis for cytokines interferon-gamma and interleukin-2. Results. Our analysis demonstrates that humoral and cellular sensitization to histocompatibility antigens prior to and after islet transplantation are associated with the failure of transplanted islets. Conclusion. Patient selection based on sensitization to donor HLA may be one of the factors crucial for the success of islet transplant. Further, in some patients, rejection of islets can be associated with sensitization to mismatched donor histocompatibility antigens.
引用
收藏
页码:180 / 187
页数:8
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