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By Nuri C Nefrologia
Akinori Miyazono, Yasuhiro Okamoto, Hironobu Nagasako, Yuko Hamasaki, Seiichiro Shishido, Takako Yoshioka, Yoshifumi Kawano
Posttransplantation lymphoproliferative disorder (PTLD) is associated with significant mortality in kidney transplant recipients. PTLD cases associated with poor prognostic factors that are refractory to reduction of immunosuppression generally require chemotherapy and immunotherapy. We present a patient with PTLD who achieved complete remission after reduction of immunosuppression alone despite having a poor prognosis. A boy with a mutation in the WT1 gene developed bilateral Wilms tumor at 15 months and received a kidney transplant at the age of 4 years...
September 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Paula Ferreira Orlandi, Marina Pontello Cristelli, Carolina Araujo Rodrigues Aldworth, Taina Veras de Sandes Freitas, Claudia Rosso Felipe, Helio Tedesco Silva Junior, Jose Osmar Medina de Abreu Pestana
INTRODUCTION: The number of elderly patients with chronic kidney disease increases progressively, challenging the allocation algorithms in a scenario of organ shortage for transplantation. OBJECTIVE: To evaluate the impact of age on patient and graft survival. METHODS: Evolution of all 366 patients greater than 60 years transplanted between 1998 and 2010 was analyzed versus a control group of 366 younger patients matched for gender, type of donor (living or deceased) and year of transplantation...
April 2015: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
A Dorling
"Accommodation" refers to a vascularized transplant that has acquired resistance to antibody-mediated rejection (AMR). The term was coined in 1990, but the phenomenon was first described after clinical ABO-incompatible (ABOi) renal transplantation in the 1980s and is recognized as a common outcome in this context today. Because of the absence, until recently of reliable animal models of allograft accommodation, it has been studied extensively by investigators in the xenotransplantation field. With recent advances in the ability to recognize and diagnose AMR in human organs, the growth of desensitization programmes for transplantation into sensitized recipients and the availability of therapies that have the potential to promote accommodation, it is timely to review the literature in this area, identifying lessons that may inform preclinical and clinical studies in the future...
March 2012: American Journal of Transplantation
Lu Huber, Nils Lachmann, Michael Dürr, Mareen Matz, Lutz Liefeldt, Hans-H Neumayer, Constanze Schönemann, Klemens Budde
Sensitization is generally referred to as the development of alloantibodies, specifically anti-human leukocyte antigen (HLA) immunoglobulin G (IgG) antibodies, most commonly caused by pregnancy, blood transfusion or a previous transplant. Despite being a well known phenomenon, there has not been a general consensus on its definition, monitoring or management. Today, 25% of the patients waitlisted for kidney transplant in the US have a panel reactive antibody (PRA) of >10% while, in the Eurotransplant zone, 14% have a PRA of >5%...
July 9, 2012: Drugs
M D Stegall, J Gloor, J L Winters, S B Moore, S Degoey
Several protocols allow for the successful transplantation of sensitized renal allograft recipients, yet no one best method has emerged. The aim of the current study was to compare the efficacy of high-dose IVIG with two different plasmapheresis (PP)-based regimens in kidney transplant recipients with high levels of donor specific alloantibody (DSA) defined as a positive T-cell cytotoxicity crossmatch. With the primary goal of achieving a negative crossmatch, we employed three protocols sequentially between April 2000 and May 2005: (i) PP, low-dose IVIG, anti-CD20 antibody (n = 32); (ii) high-dose IVIG (n = 13); and (iii) PP, low-dose IVIG, anti-CD20 antibody and pre-transplant Thymoglobulin combined with post-transplant DSA monitoring (n = 16)...
February 2006: American Journal of Transplantation
Natasha M Rogers, Hooi S Eng, Raymond Yu, Svjetlana Kireta, Eleni Tsiopelas, Greg D Bennett, Nicholas R Brook, David Gillis, Graeme R Russ, P Toby Coates
Desensitization protocols reduce donor-specific anti-HLA antibodies (DSA) and enable renal transplantation in patients with a positive complement-dependent cytotoxic cross-match (CDC-CXM). The effect of this treatment on protective antibody and immunoglobulin levels is unknown. Thirteen patients with end-stage renal disease, DSA and positive CDC-CXM underwent desensitization. Sera collected pre- and post-transplantation were analysed for anti-tetanus and anti-pneumococcal antibodies, total immunoglobulin (Ig) levels and IgG subclasses and were compared to healthy controls and contemporaneous renal transplant recipients treated with standard immunosuppression alone...
January 2011: Transplant International: Official Journal of the European Society for Organ Transplantation
Philip S Macklin, Peter J Morris, Simon R Knight
BACKGROUND: Rituximab is a B lymphocyte-depleting agent used to treat lymphoma and autoimmune diseases. Recently, it has been used for desensitization therapy in ABO-incompatible and highly sensitized recipients undergoing renal transplantation. METHODS: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Four databases and three trial registries were searched for studies comparing rituximab with non-rituximab desensitization protocols...
October 27, 2014: Transplantation
Alexander C Wiseman
Immunosuppressive agents are commonly used in the nephrologist's practice in the treatment of autoimmune and immune-mediated diseases and transplantation, and they are investigational in the treatment of AKI and ESRD. Drug development has been rapid over the past decades as mechanisms of the immune response have been better defined both by serendipity (the discovery of agents with immunosuppressive activity that led to greater understanding of the immune response) and through mechanistic study (the study of immune deficiencies and autoimmune diseases and the critical pathways or mutations that contribute to disease)...
February 5, 2016: Clinical Journal of the American Society of Nephrology: CJASN
J M Yabu, M J Pando, S Busque, M L Melcher
Sensitization remains a major barrier to kidney transplantation. Sensitized patients comprise 30% of the kidney transplant waiting list but fewer than 15% of highly sensitized patients are transplanted each year. Options for highly sensitized patients with an immunologically incompatible living donor include desensitization or kidney paired donation (KPD). However, these options when used alone may still not be sufficient to allow a compatible transplant for recipients who are broadly sensitized with cumulative calculated panel-reactive antibody (cPRA) > 95%...
January 2013: Transplantation Proceedings
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