Anti-Hla donor-specific antibody monitoring in pancreas transplantation: Role of protocol biopsies.
Pablo Daniel UvaAlejandra QuevedoJosefina RosesMaría Fernanda TonioloRoxana PilottiEduardo ChuluyanDomingo H CasadeiPublished in: Clinical transplantation (2020)
In kidney transplantation, de novo donor-specific antibodies (DSA) correlate with poor graft survival, and Consensus Guidelines recommend a protocol biopsy. In pancreas transplantation, DSA are also associated with poor graft outcomes; however, there are no recommendations on protocol biopsies. We started an antibody screening protocol on pancreas transplant patients at 0, 3, 6, 12 months, and yearly. Patients with DSA or high MFI non-DSA were considered for protocol biopsies of both organs. Results: 143 pancreas recipients were screened. 84 patients had negative antibodies throughout the study, 11 patients were found to have antibodies at graft dysfunction, and 48 patients had positive antibodies at screening without acute organ dysfunction (study group). Among the 30 non-DSA patients, 9 had protocol simultaneous pancreas and kidney biopsies performed with negative results in all of them. In contrast, among the 18 DSA patients, 15 had these biopsies performed, and 47% presented with subclinical rejection of the kidney, the pancreas, or both. In addition, some of the DSA patients without a protocol biopsy presented with rejection during the first 15 months of follow-up. Conclusion: We conclude that protocol biopsies of both grafts may play a role in the follow-up of pancreas transplant patients with de novo DSA appearance.
Keyphrases
- end stage renal disease
- ejection fraction
- randomized controlled trial
- newly diagnosed
- chronic kidney disease
- prognostic factors
- stem cells
- kidney transplantation
- type diabetes
- magnetic resonance
- intensive care unit
- adipose tissue
- mesenchymal stem cells
- clinical practice
- insulin resistance
- bone marrow
- hepatitis b virus
- extracorporeal membrane oxygenation
- drug induced
- glycemic control
- aortic dissection