New Human Leukocyte Antigen (HLA) Antibody Formation and Creatinine Elevation With Abaloparatide in Kidney Transplant Recipient.
New Human Leukocyte Antigen (HLA) Antibody Formation and Creatinine Elevation With Abaloparatide in Kidney Transplant Recipient.
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一名有肾移植史的39岁女性，因跌倒导致踝关节骨折，到内分泌科诊所进行骨质疏松症评估。她的肾移植方案（霉酚酸酯360 mg，每日两次，他克莫司0.5 mg，每日早晨和每晚0.5-1 mg，泼尼松5 mg/天）和基线肌酐（1.0-1.2 mg/dL）已稳定数年。在适当的二次检查后，她开始接受阿巴帕林80 μg皮下每日注射治疗骨质疏松症。她对治疗有良好的初始生化反应。然而，在开始阿巴罗平治疗后5个月，发现她的血清肌酐新升高（1.17至1.69 mg/dL），尽管血清他克莫司谷水平稳定，并且有两种新的人类白细胞抗原（HLA）抗体（检测到Cw 7和DP 28的抗HLA抗体）。由于考虑到免疫原性，停止了阿巴帕齐。肾活检没有排斥反应的证据，她在移植方案中重新稳定，新的基线肌酐为1.3-1.6 mg/dL。患者随后开始接受特立帕鲁肽20 μg每日皮下注射治疗2年，生化反应良好，骨矿物质密度显著改善，移植方案稳定，无免疫原性或排斥反应的其他体征。这是第一个病例报告，以提高实体器官移植受者的免疫原性的关注。版权所有© 2023作者。JBMR Plus由Wiley Periodicals LLC代表美国骨与矿物质研究学会出版。
A 39‐year‐old female with a history of kidney transplant presented to the endocrinology clinic for osteoporosis evaluation after sustaining an ankle fracture from a fall. Her kidney transplant regimen (mycophenolate mofetil 360 mg twice a day, tacrolimus 0.5 mg every morning and 0.5–1 mg every evening, prednisone 5 mg/day) and baseline creatinine (1.0–1.2 mg/dL) had been stable for several years. After an appropriate secondary workup, she was started on abaloparatide 80 μg subcutaneous daily injections for osteoporosis. She had a good initial biochemical response to therapy. However, 5 months after abaloparatide initiation she was found to have a new elevation in serum creatinine (1.17 to 1.69 mg/dL) despite stable serum tacrolimus trough levels, and two new human leukocyte antigen (HLA) antibodies (anti‐HLA antibodies detected to Cw7 and DP28). Abaloparatide was stopped due to concern for immunogenicity. There was no evidence of rejection on kidney biopsy and she was restabilized on her transplant regimen with a new baseline creatinine of 1.3–1.6 mg/dL. The patient was subsequently started on teriparatide 20 μg daily subcutaneous injections for 2 years with good biochemical response, significant improvement in bone mineral density, and stable transplant regimen without additional signs of immunogenicity or rejection. This is the first case report to raise concern about immunogenicity with abaloparatide in solid organ transplant recipients. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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DOI：
10.1007/s00198-016-3858-2
发表时间：
2017-03
期刊：
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
影响因子：
--
作者：
Fahrleitner-Pammer A;Wagner D;Krisper P;Amrein K;Dimai H
通讯作者：
Dimai H
影响因子：
8.8
作者：
Wiebe, C.;Gibson, I. W.;Nickerson, P. W.
通讯作者：
Nickerson, P. W.
影响因子：
4.1
作者：
Glover, Sarah J.;Eastell, Richard;John, Markus R.
通讯作者：
John, Markus R.
影响因子：
120.7
作者：
Miller, Paul D.;Hattersley, Gary;Christiansen, Claus
通讯作者：
Christiansen, Claus
影响因子：
4.8
作者：
Hattersley, Gary;Dean, Thomas;Gardella, Thomas J.
通讯作者：
Gardella, Thomas J.