Document Detail


Pancreas-kidney transplantation and the evolution of pancreatic autoantibodies.
MedLine Citation:
PMID:  19376387     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The recurrence or persistence of pancreatic autoantibodies after pancreas-kidney transplantation (PKT) is an intriguing finding. We prospectively analyzed 77 PKTs, searching for risk factors for the expression of these autoimmune markers and their impact on pancreas graft function. Among the 77 PKTs, 24.7% had 0 HLA matches, 20.8% displayed delayed graft function, and 14.3% had acute rejection episodes. Immunosuppression included antithymocyte globulin (ATG), tacrolimus, mycophenolate mofetil (MMF), and steroids. Sixty-five patients had both grafts functioning as a follow-up of more than 6 months. In 11 patients anti-glutamic acid decarboxylase (GAD) positivity persists (n = 8) or has recurred (n = 3), 4 of whom show increasing titers. Two patients maintain positive islet cell antibodies (ICA) and anti-GAD antibodies. The 9 patients positive for ICA included 2 who were negative before PKT and 7 who remain positive. The "positive" group (22 patients with positive ICA and/or anti-GAD) did not differ from the global group of 65 functioning PKT in terms of acute rejection episodes, HLA match, and steroid withdrawal. Among the positive patients, there were 2 with borderline glucose levels; however, among the entire "positive" group, the mean fasting glucose, HbA1c, and C-peptide measurements were not significantly different, when compared with the other 65 PKTs. In conclusion, pancreatic autoantibodies may be persistently positive or recur after PKT, despite appropriate immunosuppression. Its impact on long-term pancreas graft survival is unknown. We could not identify risk factors for their expression. An extended follow-up with monitoring and search for other risk factors may be necessary to increase our knowledge in this field.
Authors:
L Martins; J Malheiro; A C Henriques; L Dias; J Dores; F Oliveira; R Seca; R Almeida; A M Sarmento; A Cabrita; M Teixeira
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Transplantation proceedings     Volume:  41     ISSN:  0041-1345     ISO Abbreviation:  Transplant. Proc.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-20     Completed Date:  2009-07-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0243532     Medline TA:  Transplant Proc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  913-5     Citation Subset:  IM    
Affiliation:
Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Portugal. lasalete@clix.pt
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MeSH Terms
Descriptor/Qualifier:
Adult
Autoantibodies / blood*
Blood Glucose / metabolism
C-Peptide / blood
Cadaver
Diabetes Mellitus, Type 1 / surgery*
Diabetic Nephropathies / surgery*
Female
Follow-Up Studies
Hemoglobin A, Glycosylated / metabolism
Humans
Kidney Failure, Chronic / etiology,  surgery*
Kidney Transplantation / immunology*
Male
Middle Aged
Pancreas / immunology
Pancreas Transplantation / immunology*
Reference Values
Retrospective Studies
Tissue Donors
Young Adult
Chemical
Reg. No./Substance:
0/Autoantibodies; 0/Blood Glucose; 0/C-Peptide; 0/Hemoglobin A, Glycosylated

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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