Pregnancy-induced HLA antibodies respond more vigorously after renal transplantation than antibodies induced by prior transplantation.

Acute antibody mediated rejection after HLA-specific antibody incompatible renal transplantation is related to donor specific HLA antibody (DSA) levels. DSA levels may rise sharply after transplant, and aim of this study was to examine changes in DSA levels, particularly according to the primary sensitising event. Changes in 220 HLA specificities in 64 patients over the first 30days after transplantation were evaluated using microbead assays. The greatest increase from pre-treatment to peak DSA levels was seen in pregnancy-stimulated specificities, median (IQR) increase in MFI of 1981 (94-5870). The next highest increase was for those sensitised by transplant with repeat HLA epitope mismatch, at 546 (-308-2698) (p<0.01). The difference was especially marked when the pre-treatment antibody level was low; with pre-treatment MFI <1000, peak level was >1000 in 19/26 (73%) of pregnancy stimulated specificities, compared with 9/29 (31%) for all others (p<0.001). DSA production to specificities stimulated by previous pregnancy was marked, even from very low pre-transplant levels. By contrast, there was a lower rate of antibody resynthesis to specificities repeated from previous transplants, both at antigen and epitope levels.

An evaluation of multi-professional education in diabetes.

The role of multi-professional learning in diabetes care has been controversial due largely to the severe practical problems that need to be overcome to allow comparisons with the standard uni-disciplinary approach. We describe the operation and analysis of a unique university-based but community-orientated multi-professional diabetes care course over a four-year period. The analysis is based both on objective assessment of students by the teaching team and by the assessment of the course and the teaching methodology by the students following completion. The results show significant improvements in knowledge, very good perception of quality and usefulness, with a large impact on the students' clinical confidence and perceived clinical practice following completion. Analysis in nine areas of diabetic care is presented with the vast majority of responding students confirming a better community standard of care as a result. We are of the opinion that these results support the application of multi-professional learning to encourage improved community care of diabetes.