Anti HLA Abs.pptx

Anti - HLA antibodies in Solid Organ Transplantation

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2. Heidelberg Algorithm for Transplantation of Pre-sensitized High-Risk Patients was proposed Heidelberg Transplant Center reported in two independent series of 4136 and 5315 kidney transplant recipients on the increased risk of graft loss in the presence of pre-transplant class I and class II HLA antibodies, as measured by ELISA

3. An Integrative Approach for the Transplantation of High-Risk Sensitized Patients Transplantation 90(6):p 645-653, September 27, 2010 DOI: 10.1097/TP.0b013e3181ea3985

4. CTS ( Colloborative Transplant Study) In the CTS serum study, a possible association of de novo development and persistence or loss of preexisting was investigated. 83 patients with failed kidney transplants (in patients with pre-existing DSA) were compared with 83 control patients without graft loss who were matched for eight different parameters the rate of de novo DSA and also non-DSA with ≥500 MFI was higher in the graft loss than in the nonrejector group (76% versus 40%, p < 0.001 ).

5. Heidelberg High Risk Collective 80 high-risk sensitized patients who were transplanted at Heidelberg Transplant Center (following the Heidelberg Protocol) between April 2006 and November 2011 with a minimum follow-up for all patients of 36 months Despite all measures, seven patients developed AMR and six of them lost their graft within the first 4 years after transplantation , and all six patients were positive for C1q

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7. 734 patients 160 DSA positive; majority (77.5%) of DSA-positive recipients had either anti-HLA class I or II antibodies A total of 383 graft failures were recorded (50.2% of transplantations in the DSAneg group and 59.4% in the DSApos group, p < 0 . 04) Death with functioning graft occurred in 141 patients, and in 195 cases out of the 242 death-censored graft failures (80.5 %), a diagnostic renal biopsy was performed Graft failure because of rejection was diagnosed in more than half of these cases, with a significantly higher frequency of ABMR-related graft failure in the DSApos group (11.9% vs 5.4 %, p < 0 . 001).

8. Graft Survival

9. ABMR

10. TCMR

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