Hla class I sensitization in islet transplant recipients: Report from the collaborative islet transplant registry

Bashoo Naziruddin, Steve Wease, Donald Stablein, Franca B. Barton, Thierry Berney, Michael R. Rickels, Rodolfo Alejandro

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Pancreatic islet transplantation is a promising treatment option for patients severely affected with type 1 diabetes. This report from CITR presents pre and posttransplant human leukocyte antigen (HLA) class I sensitization rates in islet-alone transplantation. Data came from 303 recipients transplanted with islet-alone between January 1999 and December 2008. HLA class I sensitization was determined by the presence of anti-HLA class I antibodies. Panel-reactive antibodies (PRA) from prior to islet infusion and at 6 months, and yearly posttransplant was correlated to measures of islet graft failure. The cumulative number of mismatched HLA alleles increased with each additional islet infusion from a median of 3 for one infusion to 9 for three infusions. Pretransplant PRA was not predictive of islet graft failure. However, development of PRA >20% posttransplant was associated with 3.6-fold (p < 0.001) increased hazard ratio for graft failure. Patients with complete graft loss who had discontinued immunosuppression had significantly higher rate of PRA ≥ 20% compared to those with functioning grafts who remained on immunosuppression. Exposure to repeat HLA class I mismatch at second or third islet infusions resulted in less frequent development of de novo HLA class I antibodies when compared to increased class I mismatch. The development of HLA class I antibodies while on immunosuppression is associated with subsequent islet graft failure. The risk of sensitization may be reduced by minimizing the number of islet donors used per recipient, and in the absence of donor-specific anti-HLA antibodies, repeating HLA class I mismatches with subsequent islet infusions.

Original languageEnglish
Pages (from-to)901-908
Number of pages8
JournalCell Transplantation
Volume21
Issue number5
DOIs
StatePublished - Jun 25 2012

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Transplants
Antigens
HLA Antigens
Registries
Antibodies
Grafts
Immunoglobulin Isotypes
Immunosuppression
Islets of Langerhans Transplantation
Tissue Donors
Transplantation (surgical)
Transplant Recipients
Medical problems
Type 1 Diabetes Mellitus
Hazards
Alleles

Keywords

  • HLA class I
  • HLA sensitization
  • Islet transplantation
  • Panel reactive antibodies

ASJC Scopus subject areas

  • Cell Biology
  • Transplantation
  • Biomedical Engineering

Cite this

Hla class I sensitization in islet transplant recipients : Report from the collaborative islet transplant registry. / Naziruddin, Bashoo; Wease, Steve; Stablein, Donald; Barton, Franca B.; Berney, Thierry; Rickels, Michael R.; Alejandro, Rodolfo.

In: Cell Transplantation, Vol. 21, No. 5, 25.06.2012, p. 901-908.

Research output: Contribution to journalArticle

Naziruddin, Bashoo ; Wease, Steve ; Stablein, Donald ; Barton, Franca B. ; Berney, Thierry ; Rickels, Michael R. ; Alejandro, Rodolfo. / Hla class I sensitization in islet transplant recipients : Report from the collaborative islet transplant registry. In: Cell Transplantation. 2012 ; Vol. 21, No. 5. pp. 901-908.
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