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Improved long‐term graft function in kidney transplant recipients with donor antigen‐specific hyporeactivity
Author(s) -
Ferraris Jorge R.,
Tambutti Mónica,
Prigoshin Norma
Publication year - 2007
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2006.00621.x
Subject(s) - medicine , antigen , mycophenolate , immunosuppression , peripheral blood mononuclear cell , calcineurin , immunology , creatinine , transplantation , urology , in vitro , biochemistry , chemistry
We investigated the development of donor antigen‐specific hyporeactivity by using donor cells as stimulator cells in the MLC and comparing the pre‐ and post‐transplant responses of peripheral blood mononuclear cells. Twenty‐two haploidentical pediatric living‐relative donor recipients treated with daclizumab, methylprednisone, mofetil mycophenolate and calcineurin inhibitors were tested for study. Of these, 50% of the recipients developed in vitro donor antigen‐specific hyporeactivity. The recipients who did so have higher creatinine clearance levels at 12, 24 and 36 months post‐transplant (104, 92 and 81 mL/min/1.73 m 2 , respectively) than those who remained responsive to donor antigens (77, 74 and 70 mL/min/1.73 m 2 ) (p < 0.05). Acute rejection episodes were not observed; however, no recipients with donor‐specific hyporeactivity have been diagnosed with CAN, unlike three recipients who remained responsive to donor antigens (0% vs. 27.3%, p = 0.06). Differences in accumulative doses of methylprednisone and mofetil mycophenolate were observed between hyporeactivity‐ and response‐patients to donor antigens at the three years end‐point (1.9 ± 0.8 g/m 2 vs. 4.2 ± 0.5 g/m 2 , and 277 ± 89 g/m 2 vs. 672 ± 16.0 g/m 2 ; p < 0.01 and <0.02, respectively). We conclude that the development of donor antigen‐specific hyporeactivity correlate with improved graft function and may permit lower immunosuppression.