BACKGROUND Chronic kidney disease is associated with immunological disorders,presented as phenotypic alterations of T lymphocytes.These changes are expected to be restored after a successful renal transplantation;howe...BACKGROUND Chronic kidney disease is associated with immunological disorders,presented as phenotypic alterations of T lymphocytes.These changes are expected to be restored after a successful renal transplantation;however,additional parameters may contribute to this process.AIM To evaluate the impact of positive panel reactive antibodies(PRAs)on the restoration of T cell phenotype,after renal transplantation.METHODS CD4CD28null,CD8CD28null,natural killer cells(NKs),and regulatory T cells(Tregs)were estimated by flow cytometry at T0,T3,and T6 which were the time of transplantation,and 3-and 6-mo follow-up,respectively.Changes were estimated regarding the presence or absence of PRAs.RESULTS Patients were classified in two groups:PRA(-)(n=43)and PRA(+)(n=28)groups.Lymphocyte and their subtypes were similar between the two groups at T0,whereas their percentage was increased at T3 in PRA(-)compared to PRA(+)[23(10.9-47.9)vs 16.4(7.5-36.8)μ/L,respectively;P=0.03].Lymphocyte changes in PRA(-)patients included a significant increase in CD4 cells(P<0.0001),CD8 cells(P<0.0001),and Tregs(P<0.0001),and a reduction of NKs(P<0.0001).PRA(+)patients showed an increase in CD4(P=0.008)and CD8(P=0.0001),and a reduction in NKs(P=0.07).CD4CD28null and CD8CD28null cells,although initially reduced in both groups,were stabilized thereafter.CONCLUSION Our study described important differences in the immune response between PRA(+)and PRA(-)patients with changes in lymphocytes and lymphocyte subpopulations.PRA(+)patients seemed to have a worse immune profile after 6 mo follow-up,regardless of renal function.展开更多
Our understanding of transplant immunology has advanced from gross allograft rejection to cellular response and to current molecular level. More sensitive assays have been developed to characterize patient sensitizati...Our understanding of transplant immunology has advanced from gross allograft rejection to cellular response and to current molecular level. More sensitive assays have been developed to characterize patient sensitization and to detect pre-existing donor-specific antibodies(DSA) in pre-transplant crossmatch. After a transplant, pre-existing or de novo DSA are increasingly monitored to guide clinical management. Therefore, it is important for clinicians to understand the basic concepts and key components of transplant immunology as well as be familiarized with the modern immunological techniques used in kidney transplantation.展开更多
Objective: To evaluate the short- and long-term effects of panel reactive antibody (PRA) examination and PRA clearance on the patient/kidney survival after cadaveric renal transplantation. Method: We reviewed the reco...Objective: To evaluate the short- and long-term effects of panel reactive antibody (PRA) examination and PRA clearance on the patient/kidney survival after cadaveric renal transplantation. Method: We reviewed the records of 1 277 patients who underwent cadaveric renal transplantation with good human leukocyte antigen (HLA) matching with the donors from 1978 to 1998. Four hundred and twenty-three patients underwent renal transplantation from 1978 to 1990 without PRA examination made up the first group. The other 854 patients with PRA level examination before the operation from 1991 to 1998 were regarded as the second group. Preoperative plasmaphereses were performed for those with PM levels higher than 30%. The episodes of hyperacute rejection, acute rejection and l-, 3- and 5-year patient/graft survival rate were evaluated. To rule out the interference of different immunosuppressants, we made a comparative study between the recipients with uncorrectable high PRA levels (> 20% ) in the second group and those with reduced PRA levels (< 10% ) by plasmaphere- sis. Results: In the first group, 9 (2.l%) hyperacute rejection and 198 (47%) acute rejection occurred The 1-, 3- and 5-year patient/graft survival rates were 86. 7%/76. 3%, 72. 5%/67. 9% and 87 .0%/81. 6%, respectively. In the second group, no hyperacute rejection happened and acute rejection was occurred in 162 cases (19.0% ), and the l-, 3- and 5year patient/graft survival rates were 97. 3%/95.0%, 92%/84. 2% and 87.0%/81 .6%, much lower than that in the first group. Of the 49 recipients with high PRA levels, 33 had PRA levels below 10% after plasmapheresis, who had a lower incidence of ocute rejection, a higher rate of rejection reversal and a higher graft survival rate at 1, 3 and 5 years than the rest 16 cases (PRA > 20% after plasmapheresis). Conclusion: The PRA level examination and PRA clearance are important for the success of renal transplantation. They help eradicate the hyperacute rejection, reduce the risk of acute rejection and improve patient and graft survival.展开更多
文摘BACKGROUND Chronic kidney disease is associated with immunological disorders,presented as phenotypic alterations of T lymphocytes.These changes are expected to be restored after a successful renal transplantation;however,additional parameters may contribute to this process.AIM To evaluate the impact of positive panel reactive antibodies(PRAs)on the restoration of T cell phenotype,after renal transplantation.METHODS CD4CD28null,CD8CD28null,natural killer cells(NKs),and regulatory T cells(Tregs)were estimated by flow cytometry at T0,T3,and T6 which were the time of transplantation,and 3-and 6-mo follow-up,respectively.Changes were estimated regarding the presence or absence of PRAs.RESULTS Patients were classified in two groups:PRA(-)(n=43)and PRA(+)(n=28)groups.Lymphocyte and their subtypes were similar between the two groups at T0,whereas their percentage was increased at T3 in PRA(-)compared to PRA(+)[23(10.9-47.9)vs 16.4(7.5-36.8)μ/L,respectively;P=0.03].Lymphocyte changes in PRA(-)patients included a significant increase in CD4 cells(P<0.0001),CD8 cells(P<0.0001),and Tregs(P<0.0001),and a reduction of NKs(P<0.0001).PRA(+)patients showed an increase in CD4(P=0.008)and CD8(P=0.0001),and a reduction in NKs(P=0.07).CD4CD28null and CD8CD28null cells,although initially reduced in both groups,were stabilized thereafter.CONCLUSION Our study described important differences in the immune response between PRA(+)and PRA(-)patients with changes in lymphocytes and lymphocyte subpopulations.PRA(+)patients seemed to have a worse immune profile after 6 mo follow-up,regardless of renal function.
文摘Our understanding of transplant immunology has advanced from gross allograft rejection to cellular response and to current molecular level. More sensitive assays have been developed to characterize patient sensitization and to detect pre-existing donor-specific antibodies(DSA) in pre-transplant crossmatch. After a transplant, pre-existing or de novo DSA are increasingly monitored to guide clinical management. Therefore, it is important for clinicians to understand the basic concepts and key components of transplant immunology as well as be familiarized with the modern immunological techniques used in kidney transplantation.
文摘Objective: To evaluate the short- and long-term effects of panel reactive antibody (PRA) examination and PRA clearance on the patient/kidney survival after cadaveric renal transplantation. Method: We reviewed the records of 1 277 patients who underwent cadaveric renal transplantation with good human leukocyte antigen (HLA) matching with the donors from 1978 to 1998. Four hundred and twenty-three patients underwent renal transplantation from 1978 to 1990 without PRA examination made up the first group. The other 854 patients with PRA level examination before the operation from 1991 to 1998 were regarded as the second group. Preoperative plasmaphereses were performed for those with PM levels higher than 30%. The episodes of hyperacute rejection, acute rejection and l-, 3- and 5-year patient/graft survival rate were evaluated. To rule out the interference of different immunosuppressants, we made a comparative study between the recipients with uncorrectable high PRA levels (> 20% ) in the second group and those with reduced PRA levels (< 10% ) by plasmaphere- sis. Results: In the first group, 9 (2.l%) hyperacute rejection and 198 (47%) acute rejection occurred The 1-, 3- and 5-year patient/graft survival rates were 86. 7%/76. 3%, 72. 5%/67. 9% and 87 .0%/81. 6%, respectively. In the second group, no hyperacute rejection happened and acute rejection was occurred in 162 cases (19.0% ), and the l-, 3- and 5year patient/graft survival rates were 97. 3%/95.0%, 92%/84. 2% and 87.0%/81 .6%, much lower than that in the first group. Of the 49 recipients with high PRA levels, 33 had PRA levels below 10% after plasmapheresis, who had a lower incidence of ocute rejection, a higher rate of rejection reversal and a higher graft survival rate at 1, 3 and 5 years than the rest 16 cases (PRA > 20% after plasmapheresis). Conclusion: The PRA level examination and PRA clearance are important for the success of renal transplantation. They help eradicate the hyperacute rejection, reduce the risk of acute rejection and improve patient and graft survival.
