TY - JOUR
T1 - Clinical Significance of Alloantibodies in Hand Transplantation
T2 - A Multicenter Study
AU - Berglund, Erik
AU - Andersen Ljungdahl, Mette
AU - Bogdanović, Darko
AU - Berglund, David
AU - Wadström, Jonas
AU - Kowalski, Jan
AU - Brandacher, Gerald
AU - Kamińska, Dorota
AU - Kaufman, Christina L.
AU - Talbot, Simon G.
AU - Azari, Kodi
AU - Landin, Luis
AU - Höhnke, Christoph
AU - Dwyer, Karen M.
AU - Cavadas, Pedro C.
AU - Thione, Alessandro
AU - Clarke, Brendan
AU - Kay, Simon
AU - Wilks, Dan
AU - Iyer, Subramania
AU - Iglesias, Martin
AU - Özkan, Ömer
AU - Özkan, Özlenen
AU - Krapf, Johanna
AU - Weissenbacher, Annemarie
AU - Petruzzo, Palmina
AU - Schneeberger, Stefan
N1 - Funding Information:
22Department of Transplantation, Hôpital Edouard Herriot, HCL, Lyon, France. The study was supported by Emil and Vera Cornell’s Foundation, Stig and Gunborg Westman’s Foundation, The Foundation Blanceflor Boncompagni Ludovisi née Bildt, the Hirsch Fellowship for Surgeons, Erik and Edith Fernström´s Foundation for Medical Research, and the Swedish Society of Medicine. The authors declare no conflicts of interest.
Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Background. Donor-specific antibodies (DSAs) have a strong negative correlation with long-term survival in solid organ transplantation. Although the clinical significance of DSA and antibody-mediated rejection (AMR) in upper extremity transplantation (UET) remains to be established, a growing number of single-center reports indicate their presence and potential clinical impact. Methods. We present a multicenter study assessing the occurrence and significance of alloantibodies in UET in reference to immunological parameters and functional outcome. Results. Our study revealed a high prevalence and early development of de novo DSA and non-DSA (43%, the majority detected within the first 3 postoperative y). HLA class II mismatch correlated with antibody development, which in turn significantly correlated with the incidence of acute cellular rejection. Cellular rejections preceded antibody development in almost all cases. A strong correlation between DSA and graft survival or function cannot be statistically established at this early stage but a correlation with a lesser outcome seems to emerge. Conclusions. While the phenotype and true clinical effect of AMR remain to be better defined, the high prevalence of DSA and the correlation with acute rejection highlight the need for optimizing immunosuppression, close monitoring, and the relevance of an HLA class II match in UET recipients.
AB - Background. Donor-specific antibodies (DSAs) have a strong negative correlation with long-term survival in solid organ transplantation. Although the clinical significance of DSA and antibody-mediated rejection (AMR) in upper extremity transplantation (UET) remains to be established, a growing number of single-center reports indicate their presence and potential clinical impact. Methods. We present a multicenter study assessing the occurrence and significance of alloantibodies in UET in reference to immunological parameters and functional outcome. Results. Our study revealed a high prevalence and early development of de novo DSA and non-DSA (43%, the majority detected within the first 3 postoperative y). HLA class II mismatch correlated with antibody development, which in turn significantly correlated with the incidence of acute cellular rejection. Cellular rejections preceded antibody development in almost all cases. A strong correlation between DSA and graft survival or function cannot be statistically established at this early stage but a correlation with a lesser outcome seems to emerge. Conclusions. While the phenotype and true clinical effect of AMR remain to be better defined, the high prevalence of DSA and the correlation with acute rejection highlight the need for optimizing immunosuppression, close monitoring, and the relevance of an HLA class II match in UET recipients.
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U2 - 10.1097/TP.0000000000002650
DO - 10.1097/TP.0000000000002650
M3 - Article
C2 - 30817406
AN - SCOPUS:85068001507
SN - 0041-1337
VL - 103
SP - 2173
EP - 2182
JO - Transplantation
JF - Transplantation
IS - 10
ER -