Anti-HLA antibodies and kidney allograft outcomes in recipients with donor bone marrow cell infusion

Anti-HLA-antibodies are known to affect the allograft survival in transplant recipient patients. The aim of this study was to evaluate the association between anti-HLA antibodies and kidney allograft outcomes, particularly in recipients with concurrent donor bone marrow cell infusion [DBMI]. Between June 2006 and May 2007, forty living unrelated donor kidney transplants consisting of 20 recipients with DBMI and 20 without infusion entered into the study and were monitored prospectively for one year. Pre-and post-transplant [days 14, 30, and 90] sera were screened for the presence of anti-HLA class-I and II antibodies, and subsequently positive sera retested with ELISA specific panel for antibody specification. Of 40 patients, 9 [22.5%] experienced acute rejection episodes [ARE] [6/20 cases in non-infused versus 3/20 in DBMI patients]. The prevalence of anti-HLA antibodies before and after transplantation were higher in patients with ARE compared to non-rejecting ones [88.8% vs. 38.7%, p=0.01 and 66.6% vs. 25.8%, p=0.04, respectively]. A total of 10% [4/40] of patients developed donor specific anti-HLA antibodies [DSA] and in this regard 2 patients from the control group experienced ARE. All 3 rejecting patients in DBMI group were negative for DSA and positive for non-DSA. The lower titer of post-transplant anti-HLA antibodies were shown in DBMI patients compared to pre-transplantation titer. Additionally, the average serum creatinine levels during one year follow up and even in those patients with ARE were lower compared to controls. Our findings reveal an association between pre-and post-transplant anti-HLA antibodies, and ARE and also early allograft dysfunction. It suggests that lower incidence of ARE, undetectable DSA, lower titer of antibodies concomitant with a decrease in serum creatinine level, better allograft function and lower percentages of PRA in DBMI patients, could be the probable manifestations of partial hypo-responsiveness against allografts

Evaluation of subtypes of peripheral blood lymphocytes in patients with vitiligo

Vitiligo is characterized with white patches on the skin and alteration of melanocytes in dermoepidermal junction. Autoimmune mechanisms with an underlying genetic predisposition are the most likely causes of vitiligo. This study was performed to evaluate immune disturbance in vitiligo and clarify its more details. A total of 29 vitiligo patients and 21 healthy controls were included in this case control study. Complete blood count was measured and peripheral blood samples were evaluated floweytometrically for surface antigenic markers including CD3, CD4, CD8, CD19, CD16, CD56 and CD25 for determining the percentage and total number of various lymphocyte subgroups. Patients with different clinical subtypes were compared with each other and controls in terms of the flowcytometry results. Obtained information was assessed by SPSS statistical software. Total numbers of CD3+, CD8+ T cells, B cells and CD25+ cells were significantly increased in generalized type vitiligo patients in comparison with localized type. CD25+ cells were also increased significantly in generalized and stable types of vitiligo compared with healthy controls and finally the total number of lymphocytes was significantly decreased in localized type vitiligo patients in comparison with healthy controls.. Our data indicate cellular immune disturbance in vitiligo. Disorders of immune regulatory system may play a major role in this context. Significant CD25+ or regulatory T cells increment in different clinical subtypes of the disease is in favor of the above hypothesis. Later and larger studies may result in new and effective routs of treatment for vitiligo acting through regulating immune system

Treatment of vitiligo with blister grafting technique

Surgical treatments of vitiligo are punch grafting, blister grafting, flip-top transplantation, split skin grafting, etc aiming at rebuilding of melanocytic population in those patients who do not respond to medical treatment The objective of this study was determination of efficacy of blister grafting technique in the treatment of vitiligo. This study was done on 10 patients with vitiligo of face and /or distal extremities who had received different medical treatments including PUVA and had not responded, and their diseases were stable. Blister in recipient site was created by cryotherapy and in donor site by using vacuum device. Then donor site blister was transferred to the recipient site and bath sites were covered by dressing. 10 patients [8 females and 2 males] with mean age of 31.2 +/- 11.4 years entered the study. After 1-6 weeks, first signs of repigmentation were observed and after 4 months complete repigmentation occured in 7 patients [70%] In two patients, a repigmentation of more than 50% was observed while in one patient no pigmentation was seen which was related to errors in surgical technique. Blister grafting surgery in limited patches of vitiligo which have not responded to medical treatments gives excellent results of prolonged repigmentation without any scar formation