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Antibody-removal therapies for de novo DSA in pediatric intestinal recipients: Why, when, and how? A single-center experience
BACKGROUND: Donor-specific anti-HLA antibodies (DSA) impact negatively on the outcome of intestinal grafts. Although the use of antibody-removal therapies (ART) is becoming more frequent in the last few years, issues regarding their timing and effectiveness remain under discussion. METHODS: In the p...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9932897/ https://www.ncbi.nlm.nih.gov/pubmed/36819192 http://dx.doi.org/10.3389/fped.2022.1074577 |
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author | Lasa-Lázaro, María Ramos-Boluda, Esther Mancebo, Esther Castro-Panete, María José González-Sacristán, Rocío Serradilla, Javier Andrés-Moreno, Ane Miren Hernández-Oliveros, Francisco Paz-Artal, Estela Talayero, Paloma |
author_facet | Lasa-Lázaro, María Ramos-Boluda, Esther Mancebo, Esther Castro-Panete, María José González-Sacristán, Rocío Serradilla, Javier Andrés-Moreno, Ane Miren Hernández-Oliveros, Francisco Paz-Artal, Estela Talayero, Paloma |
author_sort | Lasa-Lázaro, María |
collection | PubMed |
description | BACKGROUND: Donor-specific anti-HLA antibodies (DSA) impact negatively on the outcome of intestinal grafts. Although the use of antibody-removal therapies (ART) is becoming more frequent in the last few years, issues regarding their timing and effectiveness remain under discussion. METHODS: In the present study, we report our experience with eight ART procedures (based on plasmapheresis, intravenous immunoglobulin, and rituximab) in eight pediatric intestinal and multivisceral transplants with de novo DSA (dnDSA). RESULTS: ART were performed when dnDSA appeared in two contexts: (1) concomitant with rejection (acute or chronic) or (2) without rejection or any other clinical symptom. Complete DSA removal was observed in seven out of eight patients, showing an effectiveness of 88%. In the group treated for dnDSA without clinical symptoms, the success rate was 100%, with complete DSA removal and without rejection afterward. A shorter time between DSA detection and ART performance appeared as a significant factor for the success of the therapy (p = 0.0002). DSA against HLA-A and DQ alleles were the most resistant to ART, whereas anti-DR DSA were the most sensitive. In addition, the 8-year allograft survival rate in recipients undergoing ART was similar to that in those without DSA, being significantly lower in non-treated DSA-positive recipients (p = 0.013). CONCLUSION: The results confirm the effectiveness of ART in terms of DSA removal and allograft survival and encourage its early use even in the absence of clinical symptoms. |
format | Online Article Text |
id | pubmed-9932897 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-99328972023-02-17 Antibody-removal therapies for de novo DSA in pediatric intestinal recipients: Why, when, and how? A single-center experience Lasa-Lázaro, María Ramos-Boluda, Esther Mancebo, Esther Castro-Panete, María José González-Sacristán, Rocío Serradilla, Javier Andrés-Moreno, Ane Miren Hernández-Oliveros, Francisco Paz-Artal, Estela Talayero, Paloma Front Pediatr Pediatrics BACKGROUND: Donor-specific anti-HLA antibodies (DSA) impact negatively on the outcome of intestinal grafts. Although the use of antibody-removal therapies (ART) is becoming more frequent in the last few years, issues regarding their timing and effectiveness remain under discussion. METHODS: In the present study, we report our experience with eight ART procedures (based on plasmapheresis, intravenous immunoglobulin, and rituximab) in eight pediatric intestinal and multivisceral transplants with de novo DSA (dnDSA). RESULTS: ART were performed when dnDSA appeared in two contexts: (1) concomitant with rejection (acute or chronic) or (2) without rejection or any other clinical symptom. Complete DSA removal was observed in seven out of eight patients, showing an effectiveness of 88%. In the group treated for dnDSA without clinical symptoms, the success rate was 100%, with complete DSA removal and without rejection afterward. A shorter time between DSA detection and ART performance appeared as a significant factor for the success of the therapy (p = 0.0002). DSA against HLA-A and DQ alleles were the most resistant to ART, whereas anti-DR DSA were the most sensitive. In addition, the 8-year allograft survival rate in recipients undergoing ART was similar to that in those without DSA, being significantly lower in non-treated DSA-positive recipients (p = 0.013). CONCLUSION: The results confirm the effectiveness of ART in terms of DSA removal and allograft survival and encourage its early use even in the absence of clinical symptoms. Frontiers Media S.A. 2023-02-02 /pmc/articles/PMC9932897/ /pubmed/36819192 http://dx.doi.org/10.3389/fped.2022.1074577 Text en © 2023 Lasa-Lázaro, Ramos-Boluda, Mancebo, Castro-Panete, González-Sacristán, Serradilla, Andrés-Moreno, Hernández Oliveros, Paz-Artal and Talayero. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pediatrics Lasa-Lázaro, María Ramos-Boluda, Esther Mancebo, Esther Castro-Panete, María José González-Sacristán, Rocío Serradilla, Javier Andrés-Moreno, Ane Miren Hernández-Oliveros, Francisco Paz-Artal, Estela Talayero, Paloma Antibody-removal therapies for de novo DSA in pediatric intestinal recipients: Why, when, and how? A single-center experience |
title | Antibody-removal therapies for de novo DSA in pediatric intestinal recipients: Why, when, and how? A single-center experience |
title_full | Antibody-removal therapies for de novo DSA in pediatric intestinal recipients: Why, when, and how? A single-center experience |
title_fullStr | Antibody-removal therapies for de novo DSA in pediatric intestinal recipients: Why, when, and how? A single-center experience |
title_full_unstemmed | Antibody-removal therapies for de novo DSA in pediatric intestinal recipients: Why, when, and how? A single-center experience |
title_short | Antibody-removal therapies for de novo DSA in pediatric intestinal recipients: Why, when, and how? A single-center experience |
title_sort | antibody-removal therapies for de novo dsa in pediatric intestinal recipients: why, when, and how? a single-center experience |
topic | Pediatrics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9932897/ https://www.ncbi.nlm.nih.gov/pubmed/36819192 http://dx.doi.org/10.3389/fped.2022.1074577 |
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