dwyer-clinicalsignificance-2019.pdf (941.55 kB)
Clinical significance of alloantibodies in hand transplantation: a multicenter study
journal contribution
posted on 2019-10-01, 00:00 authored by E Berglund, M Andersen Ljungdahl, D Bogdanović, D Berglund, J Wadström, J Kowalski, G Brandacher, D Kamińska, C L Kaufman, S G Talbot, K Azari, L Landin, C Höhnke, Karen DwyerKaren Dwyer, P C Cavadas, A Thione, B Clarke, S Kay, D Wilks, S Iyer, M Iglesias, Ö Özkan, J Krapf, A Weissenbacher, P Petruzzo, S SchneebergerBACKGROUND: Donor-specific antibodies (DSAs) have a strong negative correlation with long-term survival in solid organ transplantation. Although the clinical significance of DSA and antibody-mediated rejection (AMR) in upper extremity transplantation (UET) remains to be established, a growing number of single-center reports indicate their presence and potential clinical impact. METHODS: We present a multicenter study assessing the occurrence and significance of alloantibodies in UET in reference to immunological parameters and functional outcome. RESULTS: Our study revealed a high prevalence and early development of de novo DSA and non-DSA (43%, the majority detected within the first 3 postoperative y). HLA class II mismatch correlated with antibody development, which in turn significantly correlated with the incidence of acute cellular rejection. Cellular rejections preceded antibody development in almost all cases. A strong correlation between DSA and graft survival or function cannot be statistically established at this early stage but a correlation with a lesser outcome seems to emerge. CONCLUSIONS: While the phenotype and true clinical effect of AMR remain to be better defined, the high prevalence of DSA and the correlation with acute rejection highlight the need for optimizing immunosuppression, close monitoring, and the relevance of an HLA class II match in UET recipients.
History
Journal
TransplantationVolume
103Issue
10Pagination
2173 - 2182Publisher
Lippincott Williams & WilkinsLocation
Philadelphia, Pa.Publisher DOI
Link to full text
eISSN
1534-6080Language
engPublication classification
C1 Refereed article in a scholarly journalUsage metrics
Categories
No categories selectedKeywords
Licence
Exports
RefWorks
BibTeX
Ref. manager
Endnote
DataCite
NLM
DC