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

Posttransplant infectious complications: a prospective study on 142 kidney allograft recipients

We evaluated the posttransplant complications resulting from infections and their association with graft function, immunosuppressive drugs, and mortality. A total of 142 kidney allograft recipients were followed for 1 year after transplantation. The patients' status was assessed during regular visits, and data including clinical characteristics, infections, serum creatinine level, acute rejection episodes, immunosuppressive regimen, graft function, and mortality were recorded and analyzed. Infections occurred in 77 patients [54%]. The lower urinary [42%] and respiratory [6.3%] tracts were the most common sites of infection. The most frequent causative organisms were Klebsiella in 34 [24%] and cytomegalovirus in 25 patients [18%]. Wound infection occurred in 7 patients [5%]. The mortality rate was 7.7% and infection-related death was seen in 5 patients [3.5%] who developed sepsis. Graft loss was seen in 16 patients [11%], of whom 2 developed cytomegalovirus infection, 2 experienced urinary tract infection, and 5 developed sepsis and died. Mycobacterial and hepatitis C infections were noticeably rare [0.7% and 2.8%, respectively]. This study showed that infections are important causes of morbidity and mortality during the posttransplant period. We recommend that serologic tests be performed before and after transplantation to recognize and meticulously follow those who are at risk. In our study, high-risk patients were those with elevated serum creatinine levels who received high doses of immunosuppressive drugs. As the urinary tract is the most common site of infection, early removal of urethral catheter is recommended to reduce the risk of infection