RESUMEN
UNLABELLED: The aim of our retrospective study was to evaluate the clinical significance of measurement of the soluble CD30 (sCD30) molecule for the prediction of antibody-mediated (humoral) rejection (HR). Sixty-two kidney transplant recipients (thirty-one C4d-positive and thirty-one C4d-negative patients) were included into the study. Soluble CD30 levels were evaluated before transplantation and during periods of graft function deterioration. The median concentrations of the sCD30 molecule were identical in C4d-positive and C4d-negative patients before and after transplantation (65.5 vs. 65.0 and 28.2 vs. 36.0 U/ml, respectively). C4d+ patients who developed DSA de novo had a tendency to have higher sCD30 levels before transplantation (80.7+/-53.6 U/ml, n=8) compared with C4d-negative patients (65.0+/-33.4 U/ml, n=15). Soluble CD30 levels were evaluated as positive and negative (>or=100 U/ml and <100 U/ml respectively) and the sensitivity, specificity and accuracy of sCD30 estimation with regard to finding C4d deposits in peritubular capillaries were determined. The sensitivity of sCD30+ testing was generally below 40%, while the specificity of the test, i.e. the likelihood that if sCD30 testing is negative, C4d deposits would be absent, was 82%. C4d+ patients who developed DSA de novo were evaluated separately; the specificity of sCD30 testing for the incidence of HR in this cohort was 86%. CONCLUSION: We could not confirm in our study that high sCD30 levels (>or=100 U/ml) might be predictive for the incidence of HR. Negative sCD30 values might be however helpful for identifying patients with a low risk for development of DSA and antibody-mediated rejection.
Asunto(s)
Anticuerpos/inmunología , Rechazo de Injerto/inmunología , Antígeno Ki-1/análisis , Trasplante de Riñón/inmunología , Adulto , Anciano , Complemento C4b/análisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/análisis , Trasplante HomólogoRESUMEN
Recent literary data suggest that high pre- and post-transplant serum levels of the soluble CD30 (sCD30) molecule may be a risk factor for acute rejection and worse prognosis of the transplanted kidney. The aim of our study was to correlate the concentrations of sCD30 and the presence of HLA antibodies as defined by flow cytometry and ELISA with the clinical course and graft prognosis after transplantation. One hundred and seventeen kidney transplant patients were included into the study. The incidence of rejection episodes, graft function and graft survival for up to 1 year post-transplant were evaluated. Soluble CD30 levels before transplantation were virtually the same in patients who experienced rejection and in non-rejecting patients. In both patient groups, a significant decrease of sCD30 was detected 2 weeks after transplantation (104.4 U/ml before vs. 37.0 U/ml post-transplant, P < 0.001). However, there was a substantial difference in the level of decrease of sCD30 between rejecting and non-rejecting patients. Patients without rejection had lower sCD30 values (31.2 U/ml post-transplant) compared to patients who experienced rejection episodes (62.9 U/ml), P < 0.04. Multifactorial analysis showed that antibodies to HLA class II antigens and elevated concentrations of sCD30 shortly after transplantation were associated with increased risk for acute rejection in the first post-transplant year. Measurement of soluble CD30 after transplantation, taken into consideration with the presence of HLA class II antibodies, might be helpful for evaluating the potential risk for acute rejection.
Asunto(s)
Anticuerpos/sangre , Rechazo de Injerto/sangre , Antígenos HLA/inmunología , Antígeno Ki-1/inmunología , Trasplante de Riñón , Adulto , Anticuerpos/inmunología , Biomarcadores/sangre , Femenino , Rechazo de Injerto/inmunología , Antígenos HLA/sangre , Humanos , Antígeno Ki-1/sangre , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Factores de RiesgoRESUMEN
We have investigated the association between the presence of antibodies to HLA class II antigens and the development of acute and chronic rejection after kidney transplantation. Sera from seventy-one patients before, shortly (2 weeks), and in the period between 8 and 22 months after transplantation were analyzed by the standard complement-dependent cytotoxicity (CDC) test, ELISA-LATM, and LAT tests. Absence of antibodies to HLA class II antigens before and shortly after transplantation was associated with a lower incidence of rejection episodes in the first post-transplant year. Donor-specific class II antibodies could not be detected by the ELISA-LAT test and there was no statistically significant difference in serum creatinine levels between the antibody-positive and antibody-negative patient groups two years after transplantation. Our study suggests that anti-HLA class II antibodies represent a risk factor for the development of acute immunological complications during the first year after transplantation.
Asunto(s)
Anticuerpos/sangre , Rechazo de Injerto/etiología , Antígenos de Histocompatibilidad Clase II/inmunología , Trasplante de Riñón , Enfermedad Aguda , Adulto , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Rechazo de Injerto/epidemiología , Supervivencia de Injerto , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Factores de Riesgo , Análisis de Supervivencia , Trasplante HomólogoRESUMEN
Recent literary data suggest that antibodies to HLA antigens undetectable by the standard complement-dependent cytotoxicity test may cause not only chronic, but also acute immunological complications after kidney transplantation. The aim of this study was to investigate the significance of non-cytotoxic antibodies to HLA antigens for the development of immunological complications and a worse graft prognosis after first kidney transplantation. Sera before and early after transplantation from 120 first kidney recipients were analyzed by flow cytometry (FCXM), ELISA and the standard complement-dependent cytotoxicity (CDC) test. Pre-transplant FCXM negativity was related to a lower incidence of rejection episodes in the first post-transplant year ( P<0.01). A significant association between acute rejection and the presence of antibodies to HLA class II antigens before and after transplantation was also found ( P<0.05). Our study supports the findings of other centers of the detrimental role to the kidney graft played by anti-HLA antibodies undetectable by the classical CDC test.