Late Acute Humoral Rejection in Low-Risk Renal Transplant Recipients Induced With an Interleukin-2 Receptor Antagonist and Maintained With Standard Therapy: Preliminary Communication
Abstract Low-risk renal transplant recipients treated with standard immunosuppressive therapy including interleukin-2 receptor (IL-2R) antagonist show a low incidence of early rejection episodes but few reports have examined the incidence and severity of late rejection processes. This study evaluate...
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| Veröffentlicht in: | Transplantation proceedings 2011-07, Vol.43 (6), p.2295-2299 |
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| creator | Morales, J Contreras, L Zehnder, C Pinto, V Elberg, M Araneda, S Herzog, C Calabran, L Aguiló, J Ferrario, M Buckel, E Fierro, J.A |
| description | Abstract Low-risk renal transplant recipients treated with standard immunosuppressive therapy including interleukin-2 receptor (IL-2R) antagonist show a low incidence of early rejection episodes but few reports have examined the incidence and severity of late rejection processes. This study evaluated retrospectively cellular and antibody-mediated rejection (AMR) among 42 recipients selected because they showed low panel-reactive-antibodies, short cold ischemia time, no delayed graft function, and therapy including basiliximab (Simulect) induction. The mean observation time was 6.6 years. Sixty-seven percent of donors were deceased. Ten-year patient and death-censored graft survivals were 81% and 78%, respectively. Seven patients lost their kidneys due to nonimmunologic events. The seven recipients who experienced cellular rejection episodes during the first posttransplant year had them reversed with steroids. Five patients displayed late acute AMR causing functional deterioration in four cases including 1 graft loss. De novo sensitization occurred in 48% of recipients including patients without clinical rejection. In conclusion, long-term follow-up of kidney transplant recipients selected by a low immunologic risk showed a persistent risk of de novo sensitization evolving to acute AMR in 11% of cases. Although immunologic events were related to late immunosuppressive reduction, most graft losses were due to nonimmunologic factors. |
| doi_str_mv | 10.1016/j.transproceed.2011.06.048 |
| format | Article |
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This study evaluated retrospectively cellular and antibody-mediated rejection (AMR) among 42 recipients selected because they showed low panel-reactive-antibodies, short cold ischemia time, no delayed graft function, and therapy including basiliximab (Simulect) induction. The mean observation time was 6.6 years. Sixty-seven percent of donors were deceased. Ten-year patient and death-censored graft survivals were 81% and 78%, respectively. Seven patients lost their kidneys due to nonimmunologic events. The seven recipients who experienced cellular rejection episodes during the first posttransplant year had them reversed with steroids. Five patients displayed late acute AMR causing functional deterioration in four cases including 1 graft loss. De novo sensitization occurred in 48% of recipients including patients without clinical rejection. In conclusion, long-term follow-up of kidney transplant recipients selected by a low immunologic risk showed a persistent risk of de novo sensitization evolving to acute AMR in 11% of cases. Although immunologic events were related to late immunosuppressive reduction, most graft losses were due to nonimmunologic factors.</description><identifier>ISSN: 0041-1345</identifier><identifier>EISSN: 1873-2623</identifier><identifier>DOI: 10.1016/j.transproceed.2011.06.048</identifier><identifier>PMID: 21839258</identifier><identifier>CODEN: TRPPA8</identifier><language>eng</language><publisher>Amsterdam: Elsevier Inc</publisher><subject>Acute Disease ; Adult ; Antibodies, Monoclonal - administration & dosage ; Biological and medical sciences ; Chile ; Communicable Diseases - etiology ; Female ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Graft Rejection - immunology ; Graft Rejection - mortality ; Graft Rejection - prevention & control ; Graft Survival - drug effects ; HLA Antigens - immunology ; Humans ; Immunity, Humoral - drug effects ; Immunosuppressive Agents - administration & dosage ; Isoantibodies - blood ; Kaplan-Meier Estimate ; Kidney Transplantation - adverse effects ; Kidney Transplantation - immunology ; Kidney Transplantation - mortality ; Male ; Medical sciences ; Middle Aged ; Receptors, Interleukin-2 - antagonists & inhibitors ; Recombinant Fusion Proteins - administration & dosage ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. 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All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-2685b4d52c81a063172089de97da680e22013294ef8b289a3319bb22161c4f823</citedby><cites>FETCH-LOGICAL-c464t-2685b4d52c81a063172089de97da680e22013294ef8b289a3319bb22161c4f823</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.transproceed.2011.06.048$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>309,310,314,780,784,789,790,3550,23930,23931,25140,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24444391$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21839258$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Morales, J</creatorcontrib><creatorcontrib>Contreras, L</creatorcontrib><creatorcontrib>Zehnder, C</creatorcontrib><creatorcontrib>Pinto, V</creatorcontrib><creatorcontrib>Elberg, M</creatorcontrib><creatorcontrib>Araneda, S</creatorcontrib><creatorcontrib>Herzog, C</creatorcontrib><creatorcontrib>Calabran, L</creatorcontrib><creatorcontrib>Aguiló, J</creatorcontrib><creatorcontrib>Ferrario, M</creatorcontrib><creatorcontrib>Buckel, E</creatorcontrib><creatorcontrib>Fierro, J.A</creatorcontrib><title>Late Acute Humoral Rejection in Low-Risk Renal Transplant Recipients Induced With an Interleukin-2 Receptor Antagonist and Maintained With Standard Therapy: Preliminary Communication</title><title>Transplantation proceedings</title><addtitle>Transplant Proc</addtitle><description>Abstract Low-risk renal transplant recipients treated with standard immunosuppressive therapy including interleukin-2 receptor (IL-2R) antagonist show a low incidence of early rejection episodes but few reports have examined the incidence and severity of late rejection processes. This study evaluated retrospectively cellular and antibody-mediated rejection (AMR) among 42 recipients selected because they showed low panel-reactive-antibodies, short cold ischemia time, no delayed graft function, and therapy including basiliximab (Simulect) induction. The mean observation time was 6.6 years. Sixty-seven percent of donors were deceased. Ten-year patient and death-censored graft survivals were 81% and 78%, respectively. Seven patients lost their kidneys due to nonimmunologic events. The seven recipients who experienced cellular rejection episodes during the first posttransplant year had them reversed with steroids. Five patients displayed late acute AMR causing functional deterioration in four cases including 1 graft loss. De novo sensitization occurred in 48% of recipients including patients without clinical rejection. In conclusion, long-term follow-up of kidney transplant recipients selected by a low immunologic risk showed a persistent risk of de novo sensitization evolving to acute AMR in 11% of cases. Although immunologic events were related to late immunosuppressive reduction, most graft losses were due to nonimmunologic factors.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Antibodies, Monoclonal - administration & dosage</subject><subject>Biological and medical sciences</subject><subject>Chile</subject><subject>Communicable Diseases - etiology</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Graft Rejection - immunology</subject><subject>Graft Rejection - mortality</subject><subject>Graft Rejection - prevention & control</subject><subject>Graft Survival - drug effects</subject><subject>HLA Antigens - immunology</subject><subject>Humans</subject><subject>Immunity, Humoral - drug effects</subject><subject>Immunosuppressive Agents - administration & dosage</subject><subject>Isoantibodies - blood</subject><subject>Kaplan-Meier Estimate</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Kidney Transplantation - immunology</subject><subject>Kidney Transplantation - mortality</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Receptors, Interleukin-2 - antagonists & inhibitors</subject><subject>Recombinant Fusion Proteins - administration & dosage</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Time Factors</subject><subject>Tissue, organ and graft immunology</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0041-1345</issn><issn>1873-2623</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkttuEzEQhlcIREvhFZCFhLja4FN2vb1AisKhlYJAbRCXluOdUCe7dmp7QXkxno9ZkgjEFb6w5fE349H_T1G8YHTCKKtebyY5Gp92MViAdsIpYxNaTahUD4pzpmpR8oqLh8U5pZKVTMjpWfEkpQ3FO5ficXHGmRINn6rz4ufCZCAzO-B-NfQhmo7cwAZsdsET58ki_ChvXNpi1OPb8vfPnfEZA9btHPicyLVvBwst-eryHTEe7xliB8PW-ZKPIOxyiGTms_kWvEsZoZZ8NA4Dzp8SbzNGTWzJ8g6i2e0vyecIneudN3FP5qHvB--sGTt7Wjxamy7Bs-N5UXx5_245vyoXnz5cz2eL0spKZtRBTVeynXKrmKGVYDWnqmmhqVtTKQoctRO8kbBWK64aIwRrVivOWcWsXCsuLopXh7oo9v0AKeveJQsdCgBhSFopoWRTT2skLw-kjSGlCGu9i67HxjWjerRNb_TftunRNk0rjbZh8vPjN8Oqx7dT6sknBF4eAZOs6dZYyLr0h5O4RMOQe3vgAEX57iDqZNEi9MZF9FS3wf1fP2_-KWM7N2rfbWEPaROGiMOQNNOJa6pvx0Eb54wxivpWtfgFAgTUJQ</recordid><startdate>20110701</startdate><enddate>20110701</enddate><creator>Morales, J</creator><creator>Contreras, L</creator><creator>Zehnder, C</creator><creator>Pinto, V</creator><creator>Elberg, M</creator><creator>Araneda, S</creator><creator>Herzog, C</creator><creator>Calabran, L</creator><creator>Aguiló, J</creator><creator>Ferrario, M</creator><creator>Buckel, E</creator><creator>Fierro, J.A</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110701</creationdate><title>Late Acute Humoral Rejection in Low-Risk Renal Transplant Recipients Induced With an Interleukin-2 Receptor Antagonist and Maintained With Standard Therapy: Preliminary Communication</title><author>Morales, J ; Contreras, L ; Zehnder, C ; Pinto, V ; Elberg, M ; Araneda, S ; Herzog, C ; Calabran, L ; Aguiló, J ; Ferrario, M ; Buckel, E ; Fierro, J.A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c464t-2685b4d52c81a063172089de97da680e22013294ef8b289a3319bb22161c4f823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Antibodies, Monoclonal - administration & dosage</topic><topic>Biological and medical sciences</topic><topic>Chile</topic><topic>Communicable Diseases - etiology</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Fundamental immunology</topic><topic>Graft Rejection - immunology</topic><topic>Graft Rejection - mortality</topic><topic>Graft Rejection - prevention & control</topic><topic>Graft Survival - drug effects</topic><topic>HLA Antigens - immunology</topic><topic>Humans</topic><topic>Immunity, Humoral - drug effects</topic><topic>Immunosuppressive Agents - administration & dosage</topic><topic>Isoantibodies - blood</topic><topic>Kaplan-Meier Estimate</topic><topic>Kidney Transplantation - adverse effects</topic><topic>Kidney Transplantation - immunology</topic><topic>Kidney Transplantation - mortality</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Receptors, Interleukin-2 - antagonists & inhibitors</topic><topic>Recombinant Fusion Proteins - administration & dosage</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Surgery (general aspects). 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This study evaluated retrospectively cellular and antibody-mediated rejection (AMR) among 42 recipients selected because they showed low panel-reactive-antibodies, short cold ischemia time, no delayed graft function, and therapy including basiliximab (Simulect) induction. The mean observation time was 6.6 years. Sixty-seven percent of donors were deceased. Ten-year patient and death-censored graft survivals were 81% and 78%, respectively. Seven patients lost their kidneys due to nonimmunologic events. The seven recipients who experienced cellular rejection episodes during the first posttransplant year had them reversed with steroids. Five patients displayed late acute AMR causing functional deterioration in four cases including 1 graft loss. De novo sensitization occurred in 48% of recipients including patients without clinical rejection. In conclusion, long-term follow-up of kidney transplant recipients selected by a low immunologic risk showed a persistent risk of de novo sensitization evolving to acute AMR in 11% of cases. Although immunologic events were related to late immunosuppressive reduction, most graft losses were due to nonimmunologic factors.</abstract><cop>Amsterdam</cop><pub>Elsevier Inc</pub><pmid>21839258</pmid><doi>10.1016/j.transproceed.2011.06.048</doi><tpages>5</tpages></addata></record> |
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| subjects | Acute Disease Adult Antibodies, Monoclonal - administration & dosage Biological and medical sciences Chile Communicable Diseases - etiology Female Fundamental and applied biological sciences. Psychology Fundamental immunology Graft Rejection - immunology Graft Rejection - mortality Graft Rejection - prevention & control Graft Survival - drug effects HLA Antigens - immunology Humans Immunity, Humoral - drug effects Immunosuppressive Agents - administration & dosage Isoantibodies - blood Kaplan-Meier Estimate Kidney Transplantation - adverse effects Kidney Transplantation - immunology Kidney Transplantation - mortality Male Medical sciences Middle Aged Receptors, Interleukin-2 - antagonists & inhibitors Recombinant Fusion Proteins - administration & dosage Retrospective Studies Risk Assessment Risk Factors Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Time Factors Tissue, organ and graft immunology Treatment Outcome Young Adult |
| title | Late Acute Humoral Rejection in Low-Risk Renal Transplant Recipients Induced With an Interleukin-2 Receptor Antagonist and Maintained With Standard Therapy: Preliminary Communication |
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