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Sensitization trends after renal allograft failure: the role of DQ eplet mismatches in becoming highly sensitized
Author(s) -
Singh Pooja,
Filippone Edward J.,
Colombe Beth W.,
Shah Ashesh P.,
Zhan Tingting,
Harach Mary,
Gorn Chad,
Frank Adam M.
Publication year - 2016
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12663
Subject(s) - medicine , sensitization , intensive care medicine , immunology
Sensitization following renal allograft failure ( AF ) is highly variable. Some patients remain non‐sensitized ( NS ), while others become highly sensitized ( HS ). We studied 66 NS patients who experienced AF after initial kidney transplantation. Post‐failure, two main groups of NS panel reactive antibody ( PRA ) class I and II <10% and HS patients ( PRA class I or II ≥80%) were identified. The impact of acute rejection ( AR ), immunosuppression withdrawal ( ISW ) at AF , allograft nephrectomy, graft intolerance syndrome ( GIS ), and both standard serologic and eplet‐based mismatches ( MM ) in inducing HS status after failure was examined. Late PRA testing post‐failure revealed 18 patients remained NS and 34 patients became HS . African American recipients, ISW at AF , DQB 1 eplet MM , and presence of GIS were associated with becoming HS . Presence of total zero eplet MM , zero DQA 1/B1 eplet MM , continuation of immunosuppression after failure, and a hyporesponsive immune status characterized by recurrent infections were features of NS patients. DQ eplet MM represents a significant risk for becoming HS after AF . Studies comparing ISW vs. continuation in re‐transplant candidates with high baseline DQ eplet MM burden should be performed. This may provide insights if sensitization post‐ AF can be lessened.