RESUMEN
AIM: The influence of panel-reactive antibody level (%PRA) on crossmatch results was evaluated among 866 patients on the waiting list for cadaveric renal allografting from January 2001 to August 2005. We evaluated the results for 124 potential donors for a kidney, including 2008 crossmatches. Four hundred eighteen patients were tested against only 1 donor. METHODS: Serum samples were screened for anti-HLA antibodies using immunoglobulin (Ig)G enzyme-linked immunosorbent assay (ELISA) PRA kit and the %PRA of the most reactive sample (peak) was used for patient stratification, according to sensitization level. Crossmatches were performed on fresh donor T lymphocytes from peripheral lymph nodes, using classical and anti-human-globulin enhanced complement-dependent cytotoxicity (CDC-T) methods. The tests were performed using peak and current patient sera before and after dithiothreitol treatment. The crossmatch was assumed to be negative when no reactivity was observed in all tests. RESULTS: The incidences of positive crossmatch were as follows: 72.3%, 14.6%, and 7.2%, among patients with PRA >50%, PRA
Asunto(s)
Prueba de Histocompatibilidad/métodos , Isoanticuerpos/inmunología , Trasplante de Riñón/inmunología , Sistema del Grupo Sanguíneo ABO/inmunología , Cadáver , Rechazo de Injerto/inmunología , Humanos , Linfocitos T/inmunología , Donantes de Tejidos , Listas de EsperaRESUMEN
The purpose of the present study was to evaluate the mixed lymphocyte culture as a predictive assay of acute and chronic graft-versus-host disease (GVHD). We studied 153 patients who received a first bone marrow transplantation from human leukocyte antigen-identical siblings. Acute GVHD was observed in 26 of 128 (20.3%) patients evaluated and chronic GVHD occurred in 60 of 114 (52.6%). One-way mixed lymphocyte culture (MLC) assays were performed by the standard method. MLC results are reported as the relative response (RR) from donor against patient cells. The responses ranged from -47.0 to 40.7%, with a median of 0.5%. The Kaplan-Meier probability of developing GVHD was determined for patients with positive and negative MLC. There was no significant difference in incidence of acute GVHD between the groups studied. However, the incidence of chronic GVHD was higher in recipients with RR >4.5% than in those with RR < or =4.5%. The Cox Proportional Hazards model was used to examine the effect of MLC levels on incidence of chronic GVHD, while adjusting for the potential confounding effect of others suspected or observed risk factors. The relative risk of chronic GVHD was 2.5 for patients with positive MLC (RR >4.5%), 2.9 for those who received peripheral blood progenitor cells as a graft, and 2.2 for patients who developed previous acute GVHD. MLC was not useful for predicting acute GVHD, but MLC with RR >4.5% associated with other risk factors could predict the development of chronic GVHD, being of help for the prevention and/or treatment of this late complication.
Asunto(s)
Enfermedad Injerto contra Huésped/inmunología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Enfermedad Aguda , Adolescente , Adulto , Brasil/epidemiología , Niño , Preescolar , Enfermedad Crónica , Femenino , Enfermedad Injerto contra Huésped/epidemiología , Antígenos HLA/inmunología , Humanos , Incidencia , Prueba de Cultivo Mixto de Linfocitos/métodos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Factores de Riesgo , Trasplante HomólogoRESUMEN
The purpose of the present study was to evaluate the mixed lymphocyte culture as a predictive assay of acute and chronic graft-versus-host disease (GVHD). We studied 153 patients who received a first bone marrow transplantation from human leukocyte antigen-identical siblings. Acute GVHD was observed in 26 of 128 (20.3 percent) patients evaluated and chronic GVHD occurred in 60 of 114 (52.6 percent). One-way mixed lymphocyte culture (MLC) assays were performed by the standard method. MLC results are reported as the relative response (RR) from donor against patient cells. The responses ranged from -47.0 to 40.7 percent, with a median of 0.5 percent. The Kaplan-Meier probability of developing GVHD was determined for patients with positive and negative MLC. There was no significant difference in incidence of acute GVHD between the groups studied. However, the incidence of chronic GVHD was higher in recipients with RR >4.5 percent than in those with RR <=4.5 percent. The Cox Proportional Hazards model was used to examine the effect of MLC levels on incidence of chronic GVHD, while adjusting for the potential confounding effect of others suspected or observed risk factors. The relative risk of chronic GVHD was 2.5 for patients with positive MLC (RR >4.5 percent), 2.9 for those who received peripheral blood progenitor cells as a graft, and 2.2 for patients who developed previous acute GVHD. MLC was not useful for predicting acute GVHD, but MLC with RR >4.5 percent associated with other risk factors could predict the development of chronic GVHD, being of help for the prevention and/or treatment of this late complication
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Enfermedad Injerto contra Huésped , Trasplante de Células Madre Hematopoyéticas , Enfermedad Aguda , Brasil , Enfermedad Crónica , Enfermedad Injerto contra Huésped , Antígenos HLA , Incidencia , Prueba de Cultivo Mixto de Linfocitos , Valor Predictivo de las Pruebas , Factores de Riesgo , Trasplante HomólogoRESUMEN
The association of HLA class II haplotypes with type I diabetes was analyzed in 56 Southeastern Brazilian families using affected family-based controls (AFBAC) method. DRB1-DQA1-DQB1 alleles were determined by polymerase chain reaction/sequence-specific primer genotyping. This study first revealed the great haplotype diversity of Brazilians (65 different haplotypes even with incomplete DRB1 subtyping), probably due to the admixture of Africans genes with European and Amerindian genes in this population. The results revealed increased frequencies of the DRB1*03-DQA1*0501-DQB1*02 and DRB1*0401-DQA1*03-DQB1*0302 haplotypes in the patient group The highest risk for type I diabetes was associated with the heterozygote DRB1*03/*04 genotype as largely reported, and DRB1*03/X and DRB1*04/Y genotypes conferred a significant, but much lower disease risk. Protection from type I diabetes revealed some peculiarities in Southeastern Brazilians: a lack of significant protecting effect of the DRB1*1501-DQA1*0102-DQB1*0602 haplotype, and an apparent protection conferred by the DRB1*13-DQB1*0301, DRB1*11-DQB1*0301, and DRB1*01-DQB1*0501 two-locus haplotypes. The risk to type I diabetes in the highly diversified Southeastern Brazilians evidenced specific information to the prediction of the disease in this region of the country.
Asunto(s)
Alelos , Diabetes Mellitus Tipo 1/inmunología , Genes MHC Clase II , Antígenos HLA-DQ/genética , Antígenos HLA-DR/genética , Haplotipos , Adolescente , Adulto , Brasil , Niño , Diabetes Mellitus Tipo 1/genética , Femenino , Genotipo , Cadenas alfa de HLA-DQ , Cadenas beta de HLA-DQ , Cadenas HLA-DRB1 , Humanos , MasculinoAsunto(s)
Anticuerpos Antiidiotipos/sangre , Citotoxicidad Celular Dependiente de Anticuerpos , Antígenos HLA-A/inmunología , Trasplante de Riñón/inmunología , Linfocitos T/inmunología , Aborto Habitual/inmunología , Citotoxicidad Inmunológica , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Humanos , Técnicas Inmunológicas , Embarazo , Primer Trimestre del Embarazo , Valores de Referencia , Listas de EsperaRESUMEN
HLA class II genes are strongly associated with susceptibility and resistance to insulin-dependent diabetes mellitus (IDDM). The present study reports the HLA-DRB1 genotyping of 41 IDDM patients and 99 healthy subjects from the Southeast of Brazil (Campinas region). Both groups consisted of an ethnic mixture of Caucasian, African Negro and Amerindian origin. HLA-DRB1*03 and *04 alleles were found at significantly higher frequencies among IDDM patients compared to the controls (DRB1*03: 48.8% vs 18.2%, P < 0.005, RR = 4.27; DRB1*04: 43.9% vs 15.1%, P < 0.008, RR = 4.37) and were associated with a susceptibility to the disease. DRB1*03/*04 heterozygosity conferred a strong IDDM risk (RR = 5.44). In contrast, the HLA-DRB1*11 allele frequency was lower among IDDM patients (7.3% vs 26.3% in controls), but the difference was not significant. These data agree with those described for other populations and allow genetic characterization of IDDM in Brazil.
Asunto(s)
Alelos , Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 1/inmunología , Complejo IV de Transporte de Electrones/genética , Frecuencia de los Genes , Genoma Fúngico , Antígenos HLA-DR/genética , Saccharomyces cerevisiae/genética , Adolescente , Brasil , Susceptibilidad a Enfermedades , Femenino , Genética de Población , Genotipo , Humanos , Masculino , Población BlancaRESUMEN
It is well established that genetic and environmental factors are involved in the etiology of essential hypertension. The presence of genes predisposing to essential hypertension in the human leukocyte antigen (HLA) complex is controversial because studies of an association between HLA antigens and essential hypertension have failed to yield consistent results. Our aim in the present study was to further investigate this issue through the method of linkage analysis. Analysis of 96 hypertensive siblings distributed in 31 families indicated a significant distortion (p = 0.0009) of the normal segregation pattern of inheritance of HLA haplotypes. Thus, our data indicate that at least one of the genes responsible for genetic predisposition to essential hypertension is located very near or within the HLA complex.
Asunto(s)
Población Negra , Salud de la Familia , Familia , Antígenos HLA/genética , Haplotipos/genética , Hipertensión/genética , Población Blanca , Adolescente , Adulto , Femenino , Frecuencia de los Genes , Humanos , Hipertensión/inmunología , Masculino , Persona de Mediana Edad , LinajeRESUMEN
The survival of 502 kidney grafts (458 first-grafts and 44 second-grafts) performed at Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, was analyzed in relation to the degree of HLA compatibility. The actuarial graft survival for first-transplants, at 1 and 5 years, was a follows: a) HLA-identical donor: 90 and 83%; b) one-haplotype identical donor: 68 and 54%; c) unrelated living donor: 61 and 37.5% and d) cadaver donor: 52.5 and 32%. These survival data are similar to those reported by other transplantation groups and confirm the important role of the HLA antigens in the outcome of renal transplantation.
Asunto(s)
Supervivencia de Injerto , Antígenos HLA/inmunología , Histocompatibilidad , Trasplante de Riñón , Análisis Actuarial , Prueba de Histocompatibilidad , Humanos , Donantes de TejidosRESUMEN
The survical of 502 kidney grafts (458 first-grafts and 44 seconda-grafts) performed at Hospital das Clínicas, Faculdade de Medicina, Universidade de Säo Paulo, was analyzed in relation to the degree of HLA compatibility. The actuarial graft survival for first-transplants, at 1 and 5 years, was a follows: a) HLA-identical donor: 90 and 83%; b) one-haplotype identical donor: 68 and 54%; c) unrelated living donor: 61 and 37.5% and d) cadaver donor: 52.5 and 32%. These survival data are similar to those reported by other transplantation groups and confirm the important role of the HLA antigens in the outcome of renal transplantation