Anti-human leukocyte antigen antibodies and preemptive antibody-directed therapy after lung transplantation.
Anti-human leukocyte antigen antibodies and preemptive antibody-directed therapy after lung transplantation.
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DOI：
10.1016/j.healun.2010.05.006
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发表时间：
2010-09
期刊：
影响因子：
--
通讯作者：
Trulock EP
中科院分区：
文献类型：
--
作者：
Hachem RR;Yusen RD;Meyers BF;Aloush AA;Mohanakumar T;Patterson GA;Trulock EP
由于肺移植后供体特异性抗HLA抗体（DSA）的产生与急性和慢性排斥反应有关，我们实施了一项临床方案，对所有移植后接受DSA的受者进行筛查，并用利妥昔单抗和静脉注射免疫球蛋白（IVIG）或单独使用IVIG对发生DSA的受者进行先发制人的治疗。我们对该方案进行了一项前瞻性观察性研究，并使用LABScreen®单一抗原测定法检测移植后的DSA。我们使用考克斯比例风险模型比较了行DSA和未行DSA患者的急性排斥反应、淋巴细胞性细支气管炎和闭塞性细支气管炎综合征（BOS）的发生率，并使用Kaplan-Meier方法比较了行持续DSA和成功清除DSA患者的无BOS和生存率。在116名接受筛查的患者中，65名在研究期间发生了DSA。那些进行DSA并接受抗体导向治疗的人与未进行DSA的人相比，急性排斥反应、淋巴细胞性细支气管炎和BOS的发生率相似。此外，成功耗尽DSA的受者比持续DSA的受者有更大的BOS自由度和更好的生存率。最后，接受DSA治疗的患者与未接受DSA治疗的患者的感染并发症发生率相似。DSA的发展是令人惊讶的常见肺移植后。抗体导向治疗可能会降低与DSA相关的排斥反应的风险，但随机对照试验是必要的，以严格评估这种治疗方案的疗效。
Because the development of donor-specific anti-HLA antibodies (DSA) after lung transplantation has been associated with acute and chronic rejection we implemented a clinical protocol to screen all recipients for DSA after transplantation and preemptively treat those who develop DSA with rituximab and intravenous immune globulin (IVIG) or IVIG alone. We conducted a prospective observational study of this protocol and used the LABScreen® Single Antigen assay to detect DSA after transplantation. We compared the incidence of acute rejection, lymphocytic bronchiolitis, and bronchiolitis obliterans syndrome (BOS) between those who developed DSA and those who did not using Cox proportional hazards models and compared freedom from BOS and survival between those who had persistent DSA and those who had successful depletion of DSA using the Kaplan-Meier method. Among 116 recipients screened, 65 developed DSA during the study period. Those who developed DSA and received antibody-directed therapy had a similar incidence of acute rejection, lymphocytic bronchiolitis, and BOS as those who did not develop DSA. Furthermore, recipients who had successful depletion of DSA had greater freedom from BOS and better survival than those who had persistent DSA. Finally, those treated for DSA had a similar incidence of infectious complications as those who did not develop DSA. The development of DSA is surprisingly common after lung transplantation. Antibody-directed therapy may reduce the risk of rejection associated with DSA, but a randomized controlled trial is necessary to critically evaluate the efficacy of this treatment protocol.
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影响因子：
6.2
作者：
Palmer, SM;Davis, RD;Reinsmoen, NL
通讯作者：
Reinsmoen, NL
影响因子：
6.2
作者：
Sundaresan, S;Mohanakumar, T;Patterson, GA
通讯作者：
Patterson, GA
影响因子：
2.7
作者：
Morris, Gerald P.;Phelan, Donna L.;Mohanakumar, Thalachallour
通讯作者：
Mohanakumar, Thalachallour
DOI：
10.4049/jimmunol.182.1.309
发表时间：
2009-01-01
期刊：
Journal of immunology (Baltimore, Md. : 1950)
影响因子：
--
作者：
Fukami N;Ramachandran S;Saini D;Walter M;Chapman W;Patterson GA;Mohanakumar T
通讯作者：
Mohanakumar T
影响因子：
8.9
作者：
Girnita, AL;McCurry, KR;Zeevi, A
通讯作者：
Zeevi, A