Allosensitization of islet allograft recipients

Roberta Cardani, Antonello Pileggi, Camillo Ricordi, Carmen Gomez, David Baidal, Gaston G. Ponte, Davide Mineo, Raquel N. Faradji, Tatiana Froud, Gaetano Ciancio, Violet Esquenazi, George W Burke, Gennaro Selvaggi, Joshua Miller, Norma S Kenyon, Rodolfo Alejandro

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

BACKGROUND. The immune monitoring of islet transplant recipients includes the assessment of panel reactive antibodies (PRA). A negative association of PRA+ with allogeneic solid organ graft survival has been recognized, but scattered data is available for islet transplantation. METHODS. We performed a retrospective analysis of PRA status in 66 patients with type 1 diabetes mellitus recipient of islet allografts between 1985 and 2006. RESULTS. Pretransplant PRA+ was observed in 10 subjects in the old trials and associated with kidney transplantation and/or pregnancies. Thirteen subjects displayed PRA+ at follow-up, eight of whom were de novo. Overall, PRA+ did not correlate with islet graft outcome: long-term graft survival was observed in the presence of basal or persistent PRA+ and graft dysfunction occurred also in the absence of PRA+. Loss of graft function was associated with PRA+ after lowering of immunosuppression or after infection episodes. Loss of C-peptide did not affect kidney graft function even in simultaneous islet-kidney transplant recipients. Mostly, PRA remained negative under adequate immunosuppression. Patients whose immunosuppression was discontinued invariably developed PRA+. CONCLUSIONS. Monitoring of PRA under immunosuppression may have little clinical value under adequate immunosuppression in islet transplant recipients. The implications of allosensitization after discontinuation of immunosuppression need to be evaluated to define the real clinical impact in this patient population.

Original languageEnglish
Pages (from-to)1413-1427
Number of pages15
JournalTransplantation
Volume84
Issue number11
DOIs
StatePublished - Dec 1 2007

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Allografts
Antibodies
Immunosuppression
Transplants
Graft Survival
Kidney
Immunologic Monitoring
Tissue Survival
Islets of Langerhans Transplantation
C-Peptide
Type 1 Diabetes Mellitus
Kidney Transplantation
Pregnancy

Keywords

  • Alloantibody
  • Allosensitization
  • Diabetes
  • Graft function
  • Human leukocyte antigens
  • Islet transplantation
  • Islets of Langerhans
  • Panel reactive antibody
  • Type 1 diabetes

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Allosensitization of islet allograft recipients. / Cardani, Roberta; Pileggi, Antonello; Ricordi, Camillo; Gomez, Carmen; Baidal, David; Ponte, Gaston G.; Mineo, Davide; Faradji, Raquel N.; Froud, Tatiana; Ciancio, Gaetano; Esquenazi, Violet; Burke, George W; Selvaggi, Gennaro; Miller, Joshua; Kenyon, Norma S; Alejandro, Rodolfo.

In: Transplantation, Vol. 84, No. 11, 01.12.2007, p. 1413-1427.

Research output: Contribution to journalArticle

Cardani, R, Pileggi, A, Ricordi, C, Gomez, C, Baidal, D, Ponte, GG, Mineo, D, Faradji, RN, Froud, T, Ciancio, G, Esquenazi, V, Burke, GW, Selvaggi, G, Miller, J, Kenyon, NS & Alejandro, R 2007, 'Allosensitization of islet allograft recipients', Transplantation, vol. 84, no. 11, pp. 1413-1427. https://doi.org/10.1097/01.tp.0000290388.70019.6e
Cardani, Roberta ; Pileggi, Antonello ; Ricordi, Camillo ; Gomez, Carmen ; Baidal, David ; Ponte, Gaston G. ; Mineo, Davide ; Faradji, Raquel N. ; Froud, Tatiana ; Ciancio, Gaetano ; Esquenazi, Violet ; Burke, George W ; Selvaggi, Gennaro ; Miller, Joshua ; Kenyon, Norma S ; Alejandro, Rodolfo. / Allosensitization of islet allograft recipients. In: Transplantation. 2007 ; Vol. 84, No. 11. pp. 1413-1427.
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AU - Cardani, Roberta

AU - Pileggi, Antonello

AU - Ricordi, Camillo

AU - Gomez, Carmen

AU - Baidal, David

AU - Ponte, Gaston G.

AU - Mineo, Davide

AU - Faradji, Raquel N.

AU - Froud, Tatiana

AU - Ciancio, Gaetano

AU - Esquenazi, Violet

AU - Burke, George W

AU - Selvaggi, Gennaro

AU - Miller, Joshua

AU - Kenyon, Norma S

AU - Alejandro, Rodolfo

PY - 2007/12/1

Y1 - 2007/12/1

N2 - BACKGROUND. The immune monitoring of islet transplant recipients includes the assessment of panel reactive antibodies (PRA). A negative association of PRA+ with allogeneic solid organ graft survival has been recognized, but scattered data is available for islet transplantation. METHODS. We performed a retrospective analysis of PRA status in 66 patients with type 1 diabetes mellitus recipient of islet allografts between 1985 and 2006. RESULTS. Pretransplant PRA+ was observed in 10 subjects in the old trials and associated with kidney transplantation and/or pregnancies. Thirteen subjects displayed PRA+ at follow-up, eight of whom were de novo. Overall, PRA+ did not correlate with islet graft outcome: long-term graft survival was observed in the presence of basal or persistent PRA+ and graft dysfunction occurred also in the absence of PRA+. Loss of graft function was associated with PRA+ after lowering of immunosuppression or after infection episodes. Loss of C-peptide did not affect kidney graft function even in simultaneous islet-kidney transplant recipients. Mostly, PRA remained negative under adequate immunosuppression. Patients whose immunosuppression was discontinued invariably developed PRA+. CONCLUSIONS. Monitoring of PRA under immunosuppression may have little clinical value under adequate immunosuppression in islet transplant recipients. The implications of allosensitization after discontinuation of immunosuppression need to be evaluated to define the real clinical impact in this patient population.

AB - BACKGROUND. The immune monitoring of islet transplant recipients includes the assessment of panel reactive antibodies (PRA). A negative association of PRA+ with allogeneic solid organ graft survival has been recognized, but scattered data is available for islet transplantation. METHODS. We performed a retrospective analysis of PRA status in 66 patients with type 1 diabetes mellitus recipient of islet allografts between 1985 and 2006. RESULTS. Pretransplant PRA+ was observed in 10 subjects in the old trials and associated with kidney transplantation and/or pregnancies. Thirteen subjects displayed PRA+ at follow-up, eight of whom were de novo. Overall, PRA+ did not correlate with islet graft outcome: long-term graft survival was observed in the presence of basal or persistent PRA+ and graft dysfunction occurred also in the absence of PRA+. Loss of graft function was associated with PRA+ after lowering of immunosuppression or after infection episodes. Loss of C-peptide did not affect kidney graft function even in simultaneous islet-kidney transplant recipients. Mostly, PRA remained negative under adequate immunosuppression. Patients whose immunosuppression was discontinued invariably developed PRA+. CONCLUSIONS. Monitoring of PRA under immunosuppression may have little clinical value under adequate immunosuppression in islet transplant recipients. The implications of allosensitization after discontinuation of immunosuppression need to be evaluated to define the real clinical impact in this patient population.

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KW - Islets of Langerhans

KW - Panel reactive antibody

KW - Type 1 diabetes

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