Allosensitization of islet allograft recipients

Transplantation
Roberta CardaniRodolfo Alejandro

Abstract

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. We performed a retrospective analysis of PRA status in 66 patients with type 1 diabetes mellitus recipient of islet allografts between 1985 and 2006. 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+. Monitoring of PRA under immunosuppression may have little cli...Continue Reading

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Related Concepts

Primary Graft Dysfunction
Decreased Immunologic Activity [PE]
Graft Survival
C-Peptide
Insulin C-peptide Measurement
Adjustment Disorders
Immunosorbents
Diabetes Mellitus, Insulin-Dependent
Tissue Donors
Transplantation, Homologous

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