Am. J. Transpl :665
1969 Immediate failure Kidney recipients Patel, Terasaki, N Engl J Med 280:735, 1969 with antibodies, pos XM 24/30
Percent Cause of death Primary Graft Failure Hyperacute Rejection
Hyperacute Rejection Percent of Hyperacute % PRATransplant No < >8012>
Primary Non-function < >8012>2 % PRATransplant No. Percent of Primary Nonfunction
Graft Failure in 1 month % PRA Transplant No. Percent of Graft Failure < >8012>
Feucht, Albert, et al. Kidney Intern 43: , 1993 C4d- (N =42) C4d+ (N =43) Months Posttransplant Graft Survival (%) 90% 57% Biopsies within first month
Lederer, et al. Kidney International 59: , C4d- (N =101) C4d+ (N =117) Years Posttransplant Cumulative Survival (%) P=
Feucht, Schneeberger, et al. Kidney Int 1993: 43:1333. Lederer, Kluth-Pepper, et al. Kidney Int 2001; 59:334. Feucht, Opelz. Kidney Int 1996: 50:1464. Behr, Feucht, et al. J Heart Lung Transplant 1999; 18:904. C4d publications
Crespo, Pascual, et al. Transplantation 2001; 71:652. Mauiyyedi, Pelle, et al. J Am Soc Nephrol 2001; 12:574. Mauiyyedi, Colvin. Curr Opin Nephrol Hypertens 2002; 11:609. Mauiyyedi, Crespo, et al. J Am Soc Nephrol 2002; 13:779. Collins, Schneeberger, et al. J Am Soc Nephrol 1999; 10:2208.
Regele, Watschinger, et al. Nephrol Dial Transplant 2001; 16:2058. Bohmig, Exner, et al. J Am Soc Nephrol 2002; 13:1091. Bohmig, Exner, et al. Curr Opin Urol 2002; 12:95. Watschinger, Pascual. J Am Soc Nephrol 2002; 13:2420. Nickeleit, Zeiler, et al. J Am Soc Nephrol 2002; 13:242.
Review: Anti-HLA antibodies post transplant in solid organ transplantation McKenna, Takemoto, Terasaki Transplantation 69:319, 2000 American J Transplantation, June, 2003
El Fettouh, Cook, et al. Urology 2000; 56:369. Muller-Steinhardt, Fricke, et al. Clin Transplant 2000; 14:85. Kerman, Katz, et al. Transplant Proc 2001; 33:402. Worthington, Martin, et al. Transpl Proc 2001; 33:475. Tambur AR, Bray et al.Transplant 2000; 70:1055
Piazza, Poggi, et al. Transplantation 2001; 71:1106. Piazza, Borrelli, et al. Transpl Int 2000; 13:s439. Pelletier, Adams, et al. Am J Transplant 2002; 2:134. Palmer, Davis, et al. Transplantation 2002; 74:799. Lau, Palmer, et al. Ann Thorac Surg 2000; 69:1520. T
54% N= , Morris 72% N= , Iwaki 82% N= , Park N= , Harmer 95% After failure or removal of graft
54% N= , Morris 72% N= , Iwaki 82% N= , Park N= , Harmer 95% After failure or removal of graft
54% N= , Morris 72% N= , Iwaki 82% N= , Park N= , Harmer 95% After failure or removal of graft
54% N= , Morris 72% N= , Iwaki 82% N= , Park N= , Harmer 95% After failure or removal of graft
% ELISA AHG % Lazda N = 445 AHG 96% 33 N=825 at 5 centers 2001, El Awar AHG 152 Rosenberg, N = 254 El-Awar,Terasaki et al, Transpl Proc 34:2531, 2002 After failure or removal of graft
Time to antibody Time to failure 0<6M1yr yr Lee,Terasaki, Transpl 74:1192, 2002
Class II Years Posttransplant Time to antibody Time to failure Worthington, et al. Transplantation 2003, 75:1034
I Years Posttransplant Class I Time to antibody Time to failure Worthington, et al. Transplantation 2003, 75:1034
Renal allograft - Post transplant Chronic Rejection
To prove the role of HLA antibodies in a prospective trial, One year ago 2,551 patients with functioning transplants were tested for HLA antibodies
KIDNEY LUNG LIVER HEART 36 International transplant centers, patients tested in 2002 % HLA antibody Post-transplant
N CsA, Aza CsA, MMF FK, Aza FK, MMF < * Combination Drug No pre-tx antibody
Date of transplant in 2,551 patients 1 yr wait period Antibody 0203 No antibody
DirectorCountryTotalPositiveNegative Schonemann Germany 621 3/1055/516 Sada Japan 191 0/600/131 Semana France 159 2/81/151 Bow MA, USA 158 1/345/124 Neumann/ Michelon Brazil 156 1/202/136 Humar Croatia 151 4/351/116 Kidney Transplants
DirectorCountryTotalPositiveNegative LeforFL, USA 145 4/562/89 Piazza/ Adorno Italy 126 2/293/97 duToit/ Taljaard S.Africa 110 0/270/83 Milford/ Capenter MA, USA 107 2/326/75 McAlackPA, USA 79 1/146/65 JobimBrazil 78 0/80/70
DirectorCountryTotalPositiveNegative Slavcev Czech 71 1/302/41 Christiansen Australia 63 1/150/48 Polymenidis/ Skoura Greece 59 1/81/51 Stavropoulos- Giokas Greece 54 1/80/46 Mehra/ Panigrahi India 47 6/372/10 Zeevi PA, USA 42 1/131/29
DirectorCountryTotalPositiveNegative Crowe/Langon e TN, USA 30 0/81/22 Saidman MA, USA 24 0/40/20 Orosz/ Pelletier OH, USA 24 0/50/19 TaitAustralia 23 0/51/18 Fuggle Oxford, UK 21 1/41/17 Mahoney**/ Breggia MA, USA 9 0/20/7 Abdelnoor/ Shrayteh Lebanon 3 0/00/3
Deaths in a total 2551 patients followed one year 567 with antibody 1,984 without antibody 1 year later, 32 died 1.1% died 1.9% died P=0.08
Graft failure in a total 2551 patients followed one year 567 with antibody 1,984 without antibody 1 year later, 72 fail 2.0% fail 5.6% fail P=
Graft failure in patients without pre- transplant antibody 1,725 total 256 with antibody 1,469 without antibody 1 year later, 45 fail 1.9% fail 6.6% fail P=
The tests were done by PRA (panel reactive antibodies), but are Donor Specific antibodies found?
#11 Single antigen flow cytometry beads Produced by isolating antigens from recombinant lines, and adhering to beads Pei, Lee et al Transpl :43
#29 A1 A2 A3 A69 A66 A29 A30 Cont A26 B38 B57 B7 B52 B27 B8 B65 Cont B55 Single antigen beads
XX 10 9 XX 8 7 X X X ID Single Antigen A-Allele Typings Serum Antibodies in patients AFTER rejection Pei, Lee et al Transpl :43
XX 10 9 XX 8 7 X X X ID Single Antigen A-Allele Typings Serum Antibodies in patients AFTER rejection Pei, Lee et al Transpl :43
ID Single Antigen A-Allele Typings Serum 25 Berlin, Schonemann Recip Mism
HLA antibodies were found to predict chronic rejection in a prospective trial. They should therefore be useful in increasing or decreasing immunosuppression
Humoral Theory of Transplantation Am. J. Transpl :665 HLA antibodies cause : Hyperacute rejection Damage by early non function Acute rejection Chronic rejection
Humoral Theory of Transplantation Am. J. Transpl :665 HLA antibodies cause : Hyperacute rejection Damage by early non function Acute rejection Chronic rejection
Humoral Theory of Transplantation Am. J. Transpl :665 HLA antibodies cause : Hyperacute rejection Acute rejection
Humoral Theory of Transplantation Am. J. Transpl :665 HLA antibodies cause : Hyperacute rejection Acute rejection Chronic rejection
HLAtransplantationconference.org Los Angeles, Century Plaza Hotel Jan 31 to Feb 1, 2004