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Humoral rejection is the most common cause of solid organ transplant failure. Here, we evaluated a cohort of 49 patients who were successfully grafted with allogenic islets and determined that the appearance of donor-specific anti- HLA antibodies (DSAs) did not accelerate the rate of islet graft attrition, suggesting resistance to humoral rejection. Murine DSAs bound to allogeneic targets expressed by islet cells and induced their destruction in vitro; however, passive transfer of the same DSAs did not affect islet graft survival in murine models. Live imaging revealed that DSAs were sequestrated in the circulation of the recipients and failed to reach the endocrine cells of grafted islets. We used murine heart transplantation models to confirm that endothelial cells were the only accessible targets for DSAs, which induced the development of typical microvascular lesions in allogeneic transplants. In contrast, the vasculature of DSA-exposed allogeneic islet grafts was devoid of lesions because sprouting of recipient capillaries reestablished blood flow in grafted islets. Thus, we conclude that endothelial chimerism combined with vascular sequestration of DSAs protects islet grafts from humoral rejection. The reduced immunoglobulin concentrations in the interstitial tissue, confirmed in patients, may have important implications for biotherapies such as vaccines and monoclonal antibodies., Introduction Type 1 diabetes is one of the most prevalent chronic diseases of childhood. Epidemiologic studies have estimated that approximately 70,000 new cases are diagnosed every year and that the [...]

Summary: Background: Data are limited regarding the risk of hepatitis C virus (HCV) reinfection after treatment‐induced sustained virologic response (SVR) in patients on haemodialysis. Aims: To assess the risk of HCV reinfection among patients on haemodialysis with treatment‐induced SVR. Methods: Patients on haemodialysis patients who achieved SVR12 with interferon (IFN) or direct‐acting antiviral (DAA)‐based treatment received follow‐up at SVR24 and then biannually with HCV RNA measurements. HCV reinfection was defined as the resurgence of viremia by different viral strains beyond SVR12. The low‐risk general population who achieved SVR12 and who underwent the same post‐SVR12 surveillance served as the reference group. Crude reinfection rates per 100 person‐years (PYs) were calculated. Multivariate Cox regression analysis was performed to estimate the relative risk of HCV reinfection between the two groups. Results: We recruited 374 patients on haemodialysis and 1571 reference patients with a mean post‐SVR12 follow‐up of 4.7 and 6.1 years. All haemodialysis patients who achieved SVR12 also achieved SVR24. The incidence rates of HCV reinfection were 0.23 per 100 PYs (95% confidence interval [CI]: 0.09‐0.59) in haemodialysis patients and 0.16 per 100 PYs (95% CI: 0.10‐0.26) in the reference group. The risk of HCV reinfection in patients on haemodialysis was comparable to that in the reference patients (hazard ratio [HR]: 1.39; 95% CI: 0.44‐4.38, P = 0.57). Conclusions: The risk of HCV reinfection in patients on haemodialysis who achieve SVR12 is low and comparable to that in the low‐risk general population. HCV microelimination in this special population is feasible once universal screening and scaled‐up treatment are implemented. [ABSTRACT FROM AUTHOR]

Background: Needs assessment can determine how large the gap is between needs and available services; however, no tools are available to assess the unmet needs of renal transplant recipients. Objectives: The aim of this study was to develop the Care Needs for Organ Transplant Recipients Scale (CNOTRS) and examine its psychometric properties. Design: A cross‐sectional design for instrument development and psychometric testing. Participants: In total, 217 renal transplant recipients were recruited through convenience sampling. Methods: An initial 36‐item CNOTRS was developed after a comprehensive literature review. After the CNOTRS was tested through content validity and face validity, the factor structure was explored using exploratory factor analysis (EFA). Convergent validity was examined using Pearson's correlation between the CNOTRS and Hospital Anxiety and Depression Scale (HADS). Known‐group validity was tested by comparing CNOTRS scores of patients grouped based on whether they had experienced complications or rejection. Results: Twenty‐eight items with three factors (namely daily care and social interaction needs, psychological needs, and health system and service needs) were identified in EFA by parallel analysis and Velicer's MAP test. The psychological needs domain had a stronger positive correlation with the HADS than the other two domains. The known‐group validity was supported as a significant association between complications or rejection occurrence and unmet needs. The Cronbach's α of the CNOTRS was 0.94. Conclusions: The CNOTRS demonstrated satisfactory reliability and validity to assess the care needs for renal transplant recipients and can assist health care professionals to tailor more personalised care for their individual needs. [ABSTRACT FROM AUTHOR]

Summary: The idea of protocol biopsy is to detect subclinical pathologies, including rejection, recurrent disease, or infection for early intervention and adjustment of immunosuppressants. Nevertheless, it is not adopted by most clinicians because of its low yield rate and uncertain long‐term benefits. This retrospective study evaluated the impact of protocol biopsy on renal function and allograft survival. A two‐year protocol biopsy was proposed for 190 stable patients; 68 of them accepted [protocol biopsy (PB) group], while 122 did not [nonprotocol biopsy (NPB) group]. The rejection diagnosis was made in 13 patients by protocol biopsy, and 11 of them had borderline rejection. In the following 5 years, graft survival was better in the PB group than in the NPB group (P = 0.0143). A total of 4 and 17 patients in the PB and NPB groups, respectively, had rejection events proven by indication biopsy. Renal function was better preserved in the PB group than in the NPB group (P = 0.0107) for patients with rejection events. Nevertheless, the survival benefit disappeared by a longer follow‐up period (12‐year, P = 0.2886). In conclusion, 2‐year protocol biopsy detects subclinical pathological changes in rejection and preserves renal function by early intervention so as to prolong graft survival within 5 years. [ABSTRACT FROM AUTHOR]