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Reactivity of pretransplant cytotoxic antibodies to a selected HLA panel is not influenced by cyclosporin a, with or without plasma exchange
Author(s) -
Swanepoel Charles R.,
Cassidy Michael J. D.,
May Margaret,
Oudshoorn Machteld,
Toit Ernette Du,
Wood Lucille,
Jacobs Peter
Publication year - 1991
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.2920060107
Subject(s) - medicine , antibody , cytotoxic t cell , isoantibodies , human leukocyte antigen , panel reactive antibody , immunology , transplantation , histocompatibility , apheresis , antigen , gastroenterology , surgery , in vitro , platelet , biochemistry , chemistry
The influence of 6 weeks of cyclosporin A (CYA), followed by a further 6 weeks of this agent in combination with plasma exchange (PE), was defined on panel reactivity and titre of preformed cytotoxic antibodies in stable patients on haemodialysis awaiting renal transplantation. Nine individuals with antibodies to 30% or more of the donor panel were entered into the study, but three failed to complete the programme. Comprehensive data are available on the remaining six patients, one of whom was studied twice. The pattern of reactivity to the panel was unaltered, but antibody titres were significantly reduced ( P < 0.006). In one patient, a lymphocytoxic crossmatch performed between the patient and an HLA‐haploidentical sibling in the last week of the trial was positive, suggesting that neither procedure was successful in removing an antibody directed against the HLA antigens of a family donor. Three cadaver renal transplants were performed during or after the trial, and while two of the grafts were unsuccessful, one survives at 60 months, with good function. From these data it is concluded that neither cyclosporin A nor its combination with plasma exchange have any effect on the panel reactivity of preformed cytotoxic antibodies, whereas the titres were significantly reduced. An important and serious side effect of the apheresis procedure was the loss of fistulae in two patients.