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HLA-Specific antibodies are associated with high-grade and persistent-recurrent lung allograft acute rejection
- Source :
- The Journal of Heart and Lung Transplantation. 23:1135-1141
- Publication Year :
- 2004
- Publisher :
- Elsevier BV, 2004.
-
Abstract
- The impact of HLA-specific antibodies is not well established in the acute rejection of lung allografts. Acute rejection represents the most important risk factor for the development of chronic lung allograft dysfunction.We analyzed the pattern of HLA antibodies before and after transplantation in 54 patients, and correlated our data with the presence and frequency of high-grade and persistent-recurrent acute rejection, during the first 18 post-operative months. The diagnosis of acute rejection was based on histologic International Society for Heart and Lung Transplantation (ISHLT)-published criteria.Ten of 54 patients had a positive enzyme-linked immunoassay (ELISA) post-transplantation. In 90% of ELISA-positive patients, the presence of HLA antibodies was associated with persistent-recurrent acute rejections, compared with 34% in the ELISA-negative group (p0.005). There were 28 high-grade acute rejection episodes in the ELISA-positive group, compared with 36 in the ELISA-negative group (p0.0001). The ELISA-positive patients required a greater intensity of immunosuppressive therapy. The patients with ELISA-detected anti-HLA antibodies were at least 3-fold more likely to develop high-grade acute rejection and persistent-recurrent acute rejection, and 7-fold more likely to develop multiple episodes of persistent-recurrent acute rejection, compared with ELISA-negative patients.ELISA-based screening for the development of HLA antibodies is a reliable method that can identify lung transplant recipients at increased risk for high-grade and persistent-recurrent acute rejection. Although bronchiolitis obliterans appears as a point of no return in the evolution of lung-transplanted patients, early detection of risk factors for acute rejection could indirectly decrease the incidence of bronchiolitis obliterans. These lung-transplanted patients may benefit from an altered strategy of immunosuppression.
- Subjects :
- Graft Rejection
Male
Pulmonary and Respiratory Medicine
medicine.medical_treatment
Bronchiolitis obliterans
Enzyme-Linked Immunosorbent Assay
Human leukocyte antigen
Antibodies
HLA Antigens
Isoantibodies
Risk Factors
medicine
Humans
Lung transplantation
Risk factor
Transplantation
Lung
biology
business.industry
Histocompatibility Antigens Class I
Histocompatibility Antigens Class II
Immunosuppression
Middle Aged
medicine.disease
medicine.anatomical_structure
Acute Disease
Immunology
biology.protein
Female
Surgery
Antibody
Cardiology and Cardiovascular Medicine
business
Immunosuppressive Agents
Subjects
Details
- ISSN :
- 10532498
- Volume :
- 23
- Database :
- OpenAIRE
- Journal :
- The Journal of Heart and Lung Transplantation
- Accession number :
- edsair.doi.dedup.....747dc83ee8e1bee1d0079715842ba654