This study aims to elucidate which types of recurrent miscarriage (RM) patients experienced a livebirth after paternal lymphocyte immunotherapy (LIT) and to evaluate the perinatal outcome.
...Retrospective analysis of a multicenter, observational study which enrolled 1096 couples with a history of two or more spontaneous miscarriages without any intercalated delivery. We conducted an intention-to-treat analysis of couples with RM treated with or without LIT regarding to gestational and perinatal outcomes. We compared groups by using the Student's
-test or Kruskal-Wallis test, Fisher's exac
-test and
test when appropriate.
The success of gestation was significantly higher in the LIT group (60.1% vs. 33.1%;
< 0.001). A sub-analysis of four different immune disorder groups revealed a significantly higher success in the LIT group in all immune categories, except in patients who had autoantibodies positive. We observed no significant differences in perinatal outcomes such as gestational age at birth, preterm and extreme preterm birth, and birth weight in successful pregnancy in both groups. The success rate was significantly higher when LIT was administrated before and during pregnancy and only during pregnancy compared to only before pregnancy (
< 0.01).
Careful laboratory test phenotyping of RM patients may identify subgroups most likely to benefit and exclude those with little likelihood of benefit, and LIT during a pregnancy may significantly improve success rates.
The aim of this study was to analyze the waiting list for kidney transplantation in our hospital according to candidate's panel reactive antibodies (cPRA) and its outcomes.
One thousand six hundred ...forty patients who were on the waiting list between 2015 and 2019 were included. For the analysis, hazard ratios (HR) for transplant were estimated by Fine and Gray's regression model according to panel reactivity and HR for graft loss and death after transplantation.
The mean age was 45.39 ± 18.22 years. Male gender was predominant (61.2%), but the proportion decreased linearly with the increase in cPRA (p < 0.001). The distribution of patients according to panels were: 0% (n = 390), 1% - 49% (n = 517), 50% - 84% (n = 269), and ≥ 85% (n = 226). Transplantation was achieved in 85.5% of the sample within a median time of 8 months (CI 95%: 6.9 - 9.1). The estimated HRs for transplantation during the follow-up were 2.84 (95% CI: 2.51 - 3.34), 2.41(95%CI: 2.07 - 2.80), and 2.45(95%CI: 2.08 - 2.90) in the cPRA range of 0%, 1%-49%, and 50%-84%, respectively, compared to cPRA ≥ 85 (p < 0.001). After transplantation, the HR for graft loss was similar in the different cPRA groups, but the HR for death (0.46 95% CI 0.24-0.89 p = 0.022) was lower in the 0% cPRA group when adjusted for age, gender, and presence of donor specific antibodies (DSA).
Patients with cPRA below 85% are more than twice as likely to receive a kidney transplantation with a shorter waiting time. The risk of graft loss after transplantation was similar in the different cPRA groups, and the adjusted risk of death was lower in nonsensitized recipients.
Abstract Introduction: The anti-human globulin-enhanced complement-dependent cytotoxicity crossmatch (AHG-CDCXM) assay has been used to assess the presence of donor-specific antibodies (DSA) in ...recipient’s serum before kidney transplantation. The flow cytometric crossmatch (FCXM) assay was first introduced as an additional test. The aim of this study was to clinically validate the single use of the FCXM assay. Methods: This study compared the outcomes of a cohort of kidney transplant patients that underwent FCXM only (FCXM group) versus a cohort of kidney transplant patients that underwent AHG-CDCXM (control group). Results: Ninety-seven patients in the FCXM group and 98 controls were included. All crossmatches in the control group were negative. One patient in the FCXM group had a positive B cell crossmatch. One year after transplantation, there were no significant differences in patient survival (p = 0.591) and graft survival (p = 0.692) between the groups. Also, no significant difference was found in the incidence of Banff ≥ 1A acute cellular rejection episodes (p = 0.289). However, acute antibody-mediated rejections occurred in 3 controls (p = 0.028). Conclusion: The results showed that discontinuing the AHG-CDCXM assay does not modify the clinical outcomes in a 1-year follow-up.
Resumo Introdução: O ensaio de prova cruzada por citotoxicidade dependente do complemento antiglobulina humana (AHG-CDCXM - do inglês anti-human globulin-enhanced complement-dependent cytotoxicity crossmatch) tem sido usado para avaliar a presença de anticorpos específicos contra o doador (DSA - do inglês donor-specific antibodies) no soro do receptor antes do transplante renal. O ensaio de prova cruzada por citometria de fluxo (CFXM) foi introduzido pela primeira vez como um teste adicional. O objetivo deste estudo foi validar clinicamente o uso único do ensaio CFXM. Métodos: Este estudo comparou os resultados de uma coorte de pacientes de transplante renal que foram submetidos apenas ao CFXM (grupo CFXM) contra uma coorte de pacientes de transplante renal submetidos ao AHG-CDCXM (grupo controle). Resultados: Foram incluídos noventa e sete pacientes no grupo CFXM e 98 controles. Todas as provas cruzadas no grupo controle foram negativas. Um paciente no grupo CFXM teve uma prova cruzada positiva para células B. Um ano após o transplante, não houve diferenças significativas na sobrevida do paciente (p = 0,591) e na sobrevida do enxerto (p = 0,692) entre os grupos. Também não foi encontrada diferença significativa na incidência de episódios de rejeição aguda celular (p = 0,289) segundo critério de Banff ≥ 1A. No entanto, rejeições agudas mediadas por anticorpos ocorreram em 3 controles (p = 0,028). Conclusão: Os resultados mostraram que a interrupção do ensaio AHG-CDCXM não modifica os desfechos clínicos em um acompanhamento de 1 ano.
Currently, there is no specific immunosuppressive protocol for hepatitis C (HCV)-positive renal transplants recipients. Thus, the aim of this study was to evaluate the conversion effect to everolimus ...(EVR) on HCV in adult kidney recipients.
This is an exploratory single-center, prospective, randomized, open label controlled trial with renal allograft recipients with HCV-positive serology. Participants were randomized for conversion to EVR or maintenance of calcineurin inhibitors.
Thirty patients were randomized and 28 were followed-up for 12 months (conversion group, Group 1 =15 and control group, Group 2 =13). RT-PCR HCV levels reported in log values were comparable in both groups and among patients in the same group. The statistical analysis showed no interaction effect between time and group (p value G*M= 0.852), overtime intra-groups (p-value M=0.889) and between group (p-value G=0.286). Group 1 showed a higher incidence of dyslipidemia (p=0.03) and proteinuria events (p=0.01), while no difference was observed in the incidence of anemia (p=0.17), new onset of post-transplant diabetes mellitus (p=1.00) or urinary tract infection (p=0.60). The mean eGFR was similar in both groups.
Our study did not show viral load decrease after conversion to EVR with maintenance of antiproliferative therapy.
The value of the crossmatch test in assessing pretransplant immunological risk is vital for clinical decisions, ranging from the indication of the transplant to the guidance of induction protocols ...and treatment with immunosuppressants. The crossmatch tests in transplantation can be physical or virtual, each with its advantages and limitations. Currently, the virtual crossmatch stands out for its sensitivity and specificity compared to the physical tests. Additionally, the virtual crossmatch can be performed in less time, allowing for a reduction in cold ischemia time. It shows a good correlation with the results of physical tests and does not negatively impact graft survival. Proper communication between clinicians and the transplant immunology laboratory will lead to a deeper understanding of each patient's immunological profile, better donor-recipient selection, and improved graft survival.
Flow cytometric crossmatch (FCXM) is performed to confirm donor/recipient histocompatibility. Previous multicenter study (Liwski et al. ASHI 2012) suggested that protocol differences contribute to ...FCXM result variability and that pronase treatment improves B cell FCXM. In this study we assess the impact of pronase on FCXM results.
Donor lymphocytes, isolated from spleens/lymph nodes, were treated with pronase (4.7 U/ml) or saline. FCXM were performed at Santa Casa Lab in Porto Alegre using the Halifax protocol, acquired on BD Canto II and analyzed using a median channel fluorescence (MCF; 1024 channel) scale. 3SD cutoffs were determined by testing neg ctrl (NC) sera against 63 donor cells. Pos ctrl (PC) sera were used in each FCXM. A total of 240 FCXM (122 predicted neg; 118 predicted pos) were performed in parallel using pronase treated vs untreated cells. Pos/Neg FCXMs were predicted based on LABScreen single antigen bead testing with a 1,000 MFI cutoff.
NC serum testing shows that pronase significantly reduced B cell background reactivity (pronase MCF = 195 +/- 32 vs untreated MCF = 363 +/- 89, p < 0.001; Fig. 1). PC reactivity was not affected by pronase treatment for T and B cell FCXM (Fig. 1). Thus, pronase improved B cell FCXM signal to noise ratio. The false positive FCXM rate was similar with pronase vs untreated cells (1.3 vs 0.7% for T cell and 5.7 vs 4.9% for B cells; Fig. 2). Pronase treatment had no effect on FCXM specificity (98.7 vs 99.2% for T cell and 94.3 vs 95.1% for B cell; Fig. 3) However, B cell FCXM sensitivity was greatly improved by pronase (74.6 vs 26.3%; Fig. 4). False neg B cell FCXM rate (T+/B−) was reduced by pronase from 60% to 0%. A slight improvement in sensitivity was also seen with pronase in T cell FCXM (61.5 vs 70.3).
B cell FCXM sensitivity is unacceptably low (26.3%) when untreated cell are used. Pronase treatment greatly improves B cell FCXM sensitivity (74.6%) and decreases the rate of false negative B cell reactions by reducing the background and improving signal to noise ratio.▪
BKV-infection in kidney graft dysfunction Montagner, Juliana; Michelon, Tatiana; Fontanelle, Barbara ...
The Brazilian journal of infectious diseases,
04/2010, Volume:
14, Issue:
2
Journal Article
Peer reviewed
Open access
INTRODUCTION: BKV nephropathy (BKN) causes kidney graft loss, whose specific diagnosis is invasive and might be predicted by the early detection of active viral infection. OBJECTIVE: Determine the ...BKV-infection prevalence in late kidney graft dysfunction by urinary decoy cell (DC) and viral DNA detection in urine (viruria) and blood (viremia; active infection). METHODS: Kidney recipients with >1 month follow-up and creatinine >1.5 mg/dL and/or recent increasing >20% (n = 120) had their urine and blood tested for BKV by semi-nested PCR, DC searching, and graft biopsy. PCR-positive patients were classified as 1+, 2+, 3+. DC, viruria and viremia prevalence, sensitivity, specificity, and likelihood ratio (LR) were determined (Table 2x2). Diagnosis efficacy of DC and viruria were compared to viremia. RESULTS: DC prevalence was 25%, viruria 61.7%, and viremia 42.5%. Positive and negative patients in each test had similar clinical, immunossupressive, and histopathological characteristics. There was no case of viremia with chronic allograft nephropathy and, under treatment with sirolimus, patients had a lower viruria prevalence (p = 0.043). Intense viruria was the single predictive test for active infection (3+; LR = 2.8).1,6-4,9 CONCLUSION: DC, BKV-viruria and -viremia are commun findings under late kidney graft dysfunction. Viremia could only be predicted by intense viruria. These results should be considered under the context of BKN confirmation.
We observed a strong association between MFI values >5 k (SAB) on anti-A, B and DR DSAs and a positive flow cross. Since 2011 we do not transplant in the presence of one or more DSAs over this value. ...Our hospital offers a deceased donor kidney to every patient, provided that the flow cross is negative, regardless of the presence of DSAs below 5 k MFI. The purpose of this paper is to observe if this policy is justifiable, comparing the results of our transplants performed with and without DSAs.
360 deceased kidney Tx performed between March 2015 and December 2017 with minimum 3 months follow up were included. The graft survival, number of rejections and last serum creatinine was compared in 306 non-DSA and 54 DSAs.
The overall graft survival was 94.4% for the DSA group and 92.5% for the non-DSA group (P = 0.611). The mean creatinine was 1.65 (SD 0.92) in the DSA group and 1.61 (SD 1.19) for the non-DSA group (P = 0.822). The proportion of patients with rejection was 19.73% in the DSA group and 15.09% on the non-DSA group (P = 0.568). Mean PRA was 37% (Class I) and 41% (Class II) for the DSA group, and 9% (I) and 5% (II) for the non-DSA group. Five patients on the DSA group had PRA Class I >90%. Four (80%) are free of dialysis, and 6 patients had PRA Class II >90%. Five (83%) are free of dialysis. Of interest is the finding that 42% of the DSAs were directed to cryptic epitopes.
Our results showed no difference on survival, function and number of rejections between the patients transplanted with or without DSAs, provided that the DSA MFI is <5 k and the flow cross is negative. We believe that our policy to offer a deceased kidney donor to our patients even in the presence of low (>1,000 to 5 k MFI) DSA levels is justifiable. Display omitted
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