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Higher calcineurin inhibitor levels predict better kidney graft survival in patients with de novo donor-specific anti-HLA antibodies: a cohort study.
Béland, Marc-Antoine; Lapointe, Isabelle; Noël, Réal; Côté, Isabelle; Wagner, Eric; Riopel, Julie; Latulippe, Eva; Désy, Olivier; Béland, Stéphanie; Magee, Ciara N; Houde, Isabelle; De Serres, Sacha A.
Afiliação
  • Béland MA; Transplantation Unit, Renal Division, Department of Medicine, Faculty of Medicine, University Health Center of Quebec, Laval University, Quebec, QC, Canada.
  • Lapointe I; Transplantation Unit, Renal Division, Department of Medicine, Faculty of Medicine, University Health Center of Quebec, Laval University, Quebec, QC, Canada.
  • Noël R; Transplantation Unit, Renal Division, Department of Medicine, Faculty of Medicine, University Health Center of Quebec, Laval University, Quebec, QC, Canada.
  • Côté I; Transplantation Unit, Renal Division, Department of Medicine, Faculty of Medicine, University Health Center of Quebec, Laval University, Quebec, QC, Canada.
  • Wagner E; Immunology and Histocompatibility Laboratory, Faculty of Medicine, University Health Center of Quebec, Laval University, Quebec, QC, Canada.
  • Riopel J; Department of Pathology, Faculty of Medicine, University Health Center of Quebec, Laval University, Quebec, QC, Canada.
  • Latulippe E; Department of Pathology, Faculty of Medicine, University Health Center of Quebec, Laval University, Quebec, QC, Canada.
  • Désy O; Transplantation Unit, Renal Division, Department of Medicine, Faculty of Medicine, University Health Center of Quebec, Laval University, Quebec, QC, Canada.
  • Béland S; Transplantation Unit, Renal Division, Department of Medicine, Faculty of Medicine, University Health Center of Quebec, Laval University, Quebec, QC, Canada.
  • Magee CN; Department of Nephrology & Renal Transplantation, UCL Centre for Nephrology, Royal Free London NHS Foundation Trust, London, UK.
  • Houde I; Transplantation Unit, Renal Division, Department of Medicine, Faculty of Medicine, University Health Center of Quebec, Laval University, Quebec, QC, Canada.
  • De Serres SA; Transplantation Unit, Renal Division, Department of Medicine, Faculty of Medicine, University Health Center of Quebec, Laval University, Quebec, QC, Canada.
Transpl Int ; 30(5): 502-509, 2017 May.
Article em En | MEDLINE | ID: mdl-28186642
The development of de novo anti-HLA donor-specific antibodies (dnDSA) is associated with poorer outcomes in kidney transplant recipients. Despite this, antibody screening post-transplant is not widespread, largely because the optimal management of patients with dnDSA remains undetermined. We hypothesized that in this population, calcineurin inhibitor blood levels would be an independent predictor of graft loss. We analyzed a cohort of unsensitized patients for whom anti-HLA antibody screening was performed prospectively post-transplant. During the screening period between January 2005 and April 2016, 42 patients developed dnDSA. There was no difference in the clinical characteristics or the histological scores of patients biopsied for clinical indication versus those biopsied solely due to detection of dnDSA. Cox modeling revealed a strong relationship between mean tacrolimus levels following dnDSA detection and graft loss, with a hazard ratio of 0.49 (95% CI, 0.33-0.75), which persisted following adjustment for established independent predictors (HR, 0.52, 95% CI, 0.30-0.89). Kaplan-Meier analysis by tertiles of tacrolimus levels and receiver operating curve analysis concurred to show that a threshold of 5.3 ng/ml could be predictive of graft loss. These data suggest that anti-HLA antibody monitoring post-transplant could guide maintenance immunosuppression and improve graft outcomes.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transplante de Rim / Tacrolimo / Inibidores de Calcineurina / Sobrevivência de Enxerto / Antígenos HLA Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Transpl Int Assunto da revista: TRANSPLANTE Ano de publicação: 2017 Tipo de documento: Article País de afiliação: Canadá País de publicação: Suíça

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transplante de Rim / Tacrolimo / Inibidores de Calcineurina / Sobrevivência de Enxerto / Antígenos HLA Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Transpl Int Assunto da revista: TRANSPLANTE Ano de publicação: 2017 Tipo de documento: Article País de afiliação: Canadá País de publicação: Suíça