Allosensitization of islet allograft recipients
Allosensitization of islet allograft recipients
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DOI：
10.1097/01.tp.0000290388.70019.6e
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发表时间：
2007-12-15
期刊：
影响因子：
6.2
通讯作者：
Alejandro, Rodolfo
中科院分区：
文献类型：
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作者：
Cardani, Roberta;Pileggi, Antonello;Alejandro, Rodolfo
背景资料。胰岛移植受者的免疫监测包括群体反应性抗体(PRA)的评估。PRA+与同种异体实体器官移植存活呈负相关，但胰岛移植有零星数据可用。我们对1985年至2006年间66例接受同种异体胰岛移植的1型糖尿病患者的PRA状况进行了回顾性分析。在旧的试验中，有10名受试者在移植前观察到PRA+，并与肾移植和/或怀孕有关。13例患者在随访时显示PRA+，其中8例是从头开始。总体而言，PRA+与胰岛移植物的预后没有相关性：在基础或持续性PRA+存在的情况下观察到移植物的长期存活，在没有PRA+的情况下也会发生移植物功能障碍。移植物功能的丧失与免疫抑制降低或感染后的PRA+有关。即使在同时接受胰岛肾移植的患者中，C肽的丢失也不会影响移植肾的功能。大多数情况下，在适当的免疫抑制下，PRA仍为阴性。停用免疫抑制的患者总是发生PRA+。在足够的免疫抑制下，对胰岛移植受者进行PRA监测可能没有什么临床价值。需要评估停用免疫抑制后同种异体致敏的含义，以确定在这一患者群体中的真正临床影响。
Background. The immune monitoring of islet transplant recipients includes the assessment of panel reactive antibodies (PRA). A negative association of PRA + with allogeneic solid organ graft survival has been recognized, but scattered data is available for islet transplantation.Methods. We performed a retrospective analysis of PRA status in 66 patients with type 1 diabetes mellitus recipient of islet allografts between 1985 and 2006.Results. Pretransplant PRA+ was observed in 10 subjects in the old trials and associated with kidney transplantation and/or pregnancies. Thirteen subjects displayed PRA+ at follow-up, eight of whom were de novo. Overall, PRA+ did not correlate with islet graft outcome: long-term graft survival was observed in the presence of basal or persistent PRA+ and graft dysfunction occurred also in the absence of PRA+. Loss of graft function was associated with PRA+ after lowering of immunosuppression or after infection episodes. Loss of C-peptide did not affect kidney graft function even in simultaneous islet-kidney transplant recipients. Mostly, PRA remained negative under adequate immunosuppression. Patients whose immunosuppression was discontinued invariably developed PRA+.Conclusions.. Monitoring of PRA under immunosuppression may have little clinical value under adequate immunosuppression in islet transplant recipients. The implications of allosensitization after discontinuation of immunosuppression need to be evaluated to define the real clinical impact in this patient population.