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Proinflammatory Events Are Associated with Significant Increases in Breadth and Strength of HLA‐Specific Antibody
Author(s) -
Locke J. E.,
Zachary A. A.,
Warren D. S.,
Segev D. L.,
Houp J. A.,
Montgomery R. A.,
Leffell M. S.
Publication year - 2009
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2009.02764.x
Subject(s) - proinflammatory cytokine , medicine , kidney transplantation , transplantation , human leukocyte antigen , immunology , retrospective cohort study , antibody , inflammation , antigen
Identification of factors responsible for an increase in the breadth or strength of HLA‐specific antibody (HSA) is critical to the continued successful management and transplantation of sensitized patients. A retrospective review of our HLA registry identified 107 patients with known HSA and sufficient information in their electronic patient record to determine the presence or absence of a proinflammatory event. The patients were stratified according to transplant status [sensitized and on the transplant waitlist (n = 65); immunosuppressed recipients of a positive crossmatch (+XM) transplant (n = 42)]. Eighty‐three percent of waitlist candidates and 55% of sensitized kidney transplant recipients with a documented proinflammatory event had an associated increase in HSA. Interestingly, among patients with a culture‐proven infection, 97% of the waitlist patients and 54.8% of +XM recipients had an associated rise in HSA. Overall, proinflammatory events were associated with a greater increase among waitlist patients than +XM recipients, 5.3‐fold [IRR 5.25, (95% CI 4.03–6.85), p < 0.001] versus 2.5‐fold [IRR 2.54, (95% CI 1.64–3.95), p < 0.001] increase in HSA. Therefore, sensitized patients known to have an infection or undergoing surgery should be monitored for expansion of HSA.