RESUMO
Humoral rejection is an important cause of early and late graft loss. The late variant is difficult to diagnose and treat. There is a close correlation between sclerosing nephropathy and anti-HLA antibodies. We analyzed 113 renal allograft recipients between August 2004 and April 2007. Acute humoral rejection was defined as acute graft dysfunction in presence of donor-specific antibodies (DSA) detected by flow panel reactive antibodies (PRA) and/or C4d positive pericapilary tubules (PTC) detected histopathologically by immunofluorescent or immunoperoxidase at less than 3 months postransplantation. Late humoral rejection was defined as dysfunction occurring after 3 months postransplantation with histopathologic glomerulopathy or vasculopathy and positive C4d PTC. We included all patients who were diagnosed with early or late graft dysfunction and underwent biopsy, all of which were examined for C4d. Four patients had acute humoral rejection treated with IVIG or plasmapheresis. The patient and graft survivals were 100% and serum creatinine averaged 1.7 mg/dL. Three recipients experienced late humoral rejection at 3 to 10 years posttransplantation All received high-dose IVIG; one also was treated with thymoglobulin. Immunosuppression was switched to tacrolimus, mycophenolate mofetil, and steroids. Only one patient recovered renal function; the others returned to dialysis. Among seven patients only one had an actual PRA (>20%) and three showed 10% to 20%. However, six had a positive historical PRA of 10% to 50%. In conclusion, Recognition of acute humoral rejection has contributed to graft rescue by controlling alloantibody production through new specific immunosuppressive therapies in contrast with the clinical response to acute therapy, treatment of a chronic entity has shown poor outcomes, probably because antibody mediated chronic graft damage is already present when the late diagnosis is established by biopsy.
Assuntos
Formação de Anticorpos , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/patologia , Transplante de Rim/imunologia , Transplante de Rim/patologia , Anticorpos Monoclonais/imunologia , Anticorpos Monoclonais/uso terapêutico , Antígenos CD/imunologia , Antígenos CD20/imunologia , Soro Antilinfocitário , Biópsia , Linfócitos T CD4-Positivos/imunologia , Creatinina/sangue , Seguimentos , Rejeição de Enxerto/tratamento farmacológico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/uso terapêutico , Plasmaferese , Fatores de Tempo , Transplante Homólogo/imunologia , Transplante Homólogo/patologiaAssuntos
Sobrevivência de Enxerto , Transplante de Rim/fisiologia , Adolescente , Adulto , Idoso , Criança , Chile , Feminino , Seguimentos , Teste de Histocompatibilidade , Humanos , Transplante de Rim/imunologia , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Análise de Sobrevida , Fatores de TempoAssuntos
Rejeição de Enxerto/mortalidade , Sobrevivência de Enxerto/fisiologia , Teste de Histocompatibilidade , Transplante de Rim/mortalidade , Complicações Pós-Operatórias/mortalidade , Análise Atuarial , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Taxa de SobrevidaRESUMO
Linkage imbalance for the B and DR loci (HLA) was found in a Chilean sample of families where a member had been proposed for transplantation. The B7-DR2 and B14-DR1 haplotypes were significantly more frequent than expected. Most associations were those found in Caucasian populations.
Assuntos
Antígenos HLA-B/genética , Antígenos HLA-DR/genética , Haplótipos , Imunologia de Transplantes , Chile , Teste de Histocompatibilidade , HumanosAssuntos
Diabetes Mellitus Tipo 1/imunologia , Antígenos HLA/análise , Adolescente , Adulto , Idoso , Antígenos de Grupos Sanguíneos/genética , Criança , Pré-Escolar , Chile , Diabetes Mellitus Tipo 1/genética , Feminino , Antígenos HLA/genética , Antígenos HLA-A , Antígenos HLA-B , Antígenos HLA-C , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Lactente , Pré-Escolar , Criança , Humanos , Masculino , Feminino , Meningite por Haemophilus , Antígenos HLA , Infecções por Haemophilus , ChileRESUMO
A possible association between intrahepatic cholestasis of pregnancy (ICP) and human-leukocyte histocompatibility (HLA) antigens--used as genetic markers--was studied in 100 women with ICP compared to 100 multiparous women without a past history of the disease. Because we previously found a higher frequency of ICP in women with an overt Araucanian Indian descent than in Chilean Caucasoids, women from both ethnic groups were studied. Among the 37 specificities of the HLA system studied (17 of HLA-A, 16 of HLA-B, and 4 of HLA-C series), only HLA-BW16 showed a tendency to be more frequent in women with ICP rather than in control women. This finding appears to be related with ethnic origin and not ICP, HLA-BW16 was significantly more frequent in women with Araucanian Indian descent (43.4%) than in Chilean Caucasoids (16.3%) (p less than 0.01). The high frequency of HLA-BW16 in the predominantly Caucasoid population in Chile, in comparison with Caucasians in Europe and in North America, may be another indicator of their ethnic admixture with aborigine groups. The high frequency of HLA-BW16 reported in North American Indian-admixed groups (16%) suggests that HLA-BW16 may be a genetic characteristic common to some aboriginal populations in North and South America.
Assuntos
Colestase Intra-Hepática/imunologia , Antígenos HLA/análise , Complicações na Gravidez/imunologia , Sistema ABO de Grupos Sanguíneos , Adolescente , Adulto , Chile , Colestase Intra-Hepática/epidemiologia , Colestase Intra-Hepática/genética , Feminino , Marcadores Genéticos , Antígenos HLA/genética , Humanos , Indígenas Sul-Americanos , Paridade , Gravidez , População BrancaRESUMO
El objetivo de esta experiencia consiste de diferentes parametros inmunologicos, humorales y celulares en un grupo de enfermos con fiebre tifoidea; asimismo, en la medida de lo posible, se trata de establecer alguna forma de relacion entre los cambios observados y la evolucion clinico bacteriologica