Back to Search
Start Over
Prognostic tools to assess candidacy for and efficacy of antibody-removal therapy
- Source :
- American Journal of Transplantation. 19:381-390
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Currently, the ability to predict or monitor the efficacy of HLA antibody-removal therapies is deficient. We previously reported that titration studies are a consistent and accurate means of assessing antibody strength. To test whether titration studies can also predict which patients are better candidates for desensitization, we studied 38 patients from 3 centers (29 receiving plasmapheresis/low-dose intravenous immunoglobulin [IVIg]; 9 patients receiving high-dose IVIg). For patients undergoing plasmapheresis/low-dose IVIg, antibody titer reduction correlated with number of treatment cycles for both class I and II antibodies but only up to approximately 4 cycles. Reduction in titer slowed with additional cycles, suggesting a limit to the efficacy of this approach. Furthermore, initial titer (predesensitization) can guide the selection of candidates for successful antibody-removal treatment. In our experience, patients with antibodies at an initial titer >1:512 could not be reduced to the goal of a negative lymphocyte crossmatch, corresponding to a 1:16 titer, despite a significant increase in the number of treatment cycles. Change in mean fluorescence intensity (MFI) value did not correlate with success of treatment if initial MFI values were >10 000, likely due to single antigen bead saturation. Overall, we present a potential prognostic tool to predict candidacy and a monitoring tool to assess efficacy of desensitization treatment.
- Subjects :
- Adult
Graft Rejection
Male
Oncology
medicine.medical_specialty
medicine.medical_treatment
Lymphocyte
Human leukocyte antigen
030230 surgery
Kidney Function Tests
03 medical and health sciences
0302 clinical medicine
Desensitization (telecommunications)
HLA Antigens
Isoantibodies
Internal medicine
Humans
Immunology and Allergy
Medicine
Pharmacology (medical)
Aged
Retrospective Studies
Transplantation
biology
business.industry
Graft Survival
Antibody titer
Immunoglobulins, Intravenous
Plasmapheresis
Middle Aged
Kidney Transplantation
Histocompatibility
Titer
Treatment Outcome
medicine.anatomical_structure
Desensitization, Immunologic
biology.protein
Kidney Failure, Chronic
Female
Antibody
business
Follow-Up Studies
Glomerular Filtration Rate
Subjects
Details
- ISSN :
- 16006135
- Volume :
- 19
- Database :
- OpenAIRE
- Journal :
- American Journal of Transplantation
- Accession number :
- edsair.doi.dedup.....5da9c3a98c8f6b8a0f18de855cc1ec0e