| Anti-human leukocyte antigen antibodies and preemptive antibody-directed therapy after lung transplantation. | |
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MedLine Citation:
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PMID: 20558084 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Because the development of donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA) after lung transplantation has been associated with acute and chronic rejection, we implemented a clinical protocol to screen all transplant recipients for DSA and preemptively treat those who developed DSA with rituximab and intravenous immune globulin (IVIG), or IVIG alone. METHODS: 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. We used the Kaplan-Meier method to compare freedom from BOS and survival between those who had persistent DSA and those who had successful depletion of DSA. RESULTS: Among 116 recipients screened, DSA developed in 65 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. CONCLUSIONS: 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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Authors:
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Ramsey R Hachem; Roger D Yusen; Bryan F Meyers; Aviva A Aloush; Thalachallour Mohanakumar; G Alexander Patterson; Elbert P Trulock |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural Date: 2010-06-16 |
Journal Detail:
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Title: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Volume: 29 ISSN: 1557-3117 ISO Abbreviation: J. Heart Lung Transplant. Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-23 Completed Date: 2010-12-30 Revised Date: 2011-09-13 |
Medline Journal Info:
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Nlm Unique ID: 9102703 Medline TA: J Heart Lung Transplant Country: United States |
Other Details:
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Languages: eng Pagination: 973-80 Citation Subset: IM |
Copyright Information:
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Copyright 2010 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA. Rhachem@dom.wustl.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Animals Antibodies / therapeutic use* Antibodies, Monoclonal / therapeutic use Antilymphocyte Serum / therapeutic use* Autoantibodies / blood* Bronchiolitis / immunology Bronchiolitis Obliterans / immunology Cytomegalovirus Infections / drug therapy Double-Blind Method Female Graft Rejection / drug therapy, immunology*, prevention & control HLA Antigens / immunology* Horses Humans Immunoglobulins, Intravenous / therapeutic use Immunosuppressive Agents / therapeutic use Isoantibodies / immunology Lung Transplantation / immunology* Male Middle Aged Postoperative Complications / virology Recombinant Fusion Proteins / therapeutic use Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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HL 056643-13A1/HL/NHLBI NIH HHS; R01 HL056643-13A1/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Antibodies; 0/Antibodies, Monoclonal; 0/Antilymphocyte Serum; 0/Autoantibodies; 0/HLA Antigens; 0/Immunoglobulins, Intravenous; 0/Immunosuppressive Agents; 0/Isoantibodies; 0/Recombinant Fusion Proteins; 0/basiliximab |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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