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37-OR: Soluble CD30 predicts early allograft function following human lung transplantation
Abstracts
S119
37-OR
SOLUBLE CD30 PREDICTS EARLY ALLOGRAFT FUNCTION FOLLOWING HUMAN LUNG TRANSPLANTATION. Ashish S. Shah,1 M. Sue Leffell,2 Donna P. Lucas,2 Andrea A. Zachary.2 1Surgery/ Cardiac Surgery, Johns Hopkins Medical Institute, Baltimore, MD, USA; 2Medicine, Johns Hopkins Medical Institute, Baltimore, MD, USA. Early allograft function after lung transplantion (LTx) can be variable. Conventional clinical criteria have limited predictive value, however recipient immunologic state prior to LTx may impact early lung function. We chose to examine pretransplant soluble CD30 (sCD30), a marker of T-cell activation, and its association with early clinical parameters of allograft function. Methods: Between 9/2002 and 1/2007, 80 transplants were performed at Johns Hopkins Hospital. 43 patients had pretransplant serum available. sCD30 was determined using a commercially available kit (human sCD30 Instant ELISA, Bender MedSystems, Burlingame, CA). Pre and post operative patient variables were collected and patients stratified into two groups: sCD30⬍20 (lowCD30) and ⬎20 (highCD30). Continuous variables were compared using ANOVA, dichotomous variables compared with Chi square, and actuarial survival was compared using long rank test. Results: highCD30 (n⫽26) and low CD30 (n⫽17) groups were similar in age, gender, and ischemic time. In the highCD30 group, a greater percentage of patients had pulmonary fibrosis and fewer had emphysema. Pa02/Fi02 ratio at 48hrs was significantly worse in the highCD30 group as compared to lowCD30 (p⫽0.003). Moreover, prolonged intubation and 90 day mortality was greater in the highCD30 group. Discharge pulmonary function and overall actuarial survival was not significantly different. Conclusion: This represents the first report of the use of sCD30 as a marker for early allograft function in human LTx. Pretransplant recipient sCD30 appears to be associated with early post transplant gas exchange, prolonged intubation, and early mortality.
38-OR
PRESENSITIZATION OF KIDNEY TRANSPLANT RECIPIENTS AGAINST MICA ANTIGENS IS ASSOCIATED WITH EARLY RENAL ALLOGRAFT REJECTION. Yizhou Zou,1 Gerhard Opelz,2 Caner Susal,2 Bernd Dohler,2 Peter Stastny.1 1Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA; 2Transplantation Immunology, University of Heidelberg, Heidelberg, Germany. MHC class I related chain A (MICA) antigens are polymorphic and we have previously shown that they can elicit antibody production in kidney transplant recipients. Although HLA matching improves the outcome of kidney transplantation, it is known that some kidney transplants fail despite such negative lymphocyte crossmatches, suggesting that other antigens might be targets for rejection. We sought to determine whether an immune response to MICA antigens might play a role in kidney allograft failure. Pre-transplantation sera from 1,910 recipients of deceased donor kidney transplants were tested for anti-MICA antibodies with Luminex flow cytometry in which single MICA antigens are attached to polystyrene microspheres. Antibodies against MICA alleles were detected in 217 of 1,910 patients (11.4%). One-year graft survival rate was 88.3 ⫾2.2% in recipients with anti-MICA antibodies as compared to a 93.0⫾0.6% in recipients without MICA antibodies (P⫽0.014). Among recipients of first kidney transplants, the survival rate was even lower in MICA antibodypositive patients (87.8⫾2.4%) as compared to MICA antibody-negative recipients (93.5⫾0.6, p⫽0.005). Additionally, among 326 recipients who received 0 or 1 HLA-A⫹B⫹DR mismatch, the recipients with sensitization against MICA had a poorer allograft survival, comparing those without such antibodies (83.2⫾5.8% vs. 95.1⫾1.3, p⫽0.002). We conclude that presensitization of kidney transplant recipients against MICA antigens is associated with an increased graft loss and might be particularly important in recipients receiving organs from HLA well-matched donors.
S119
37-OR
SOLUBLE CD30 PREDICTS EARLY ALLOGRAFT FUNCTION FOLLOWING HUMAN LUNG TRANSPLANTATION. Ashish S. Shah,1 M. Sue Leffell,2 Donna P. Lucas,2 Andrea A. Zachary.2 1Surgery/ Cardiac Surgery, Johns Hopkins Medical Institute, Baltimore, MD, USA; 2Medicine, Johns Hopkins Medical Institute, Baltimore, MD, USA. Early allograft function after lung transplantion (LTx) can be variable. Conventional clinical criteria have limited predictive value, however recipient immunologic state prior to LTx may impact early lung function. We chose to examine pretransplant soluble CD30 (sCD30), a marker of T-cell activation, and its association with early clinical parameters of allograft function. Methods: Between 9/2002 and 1/2007, 80 transplants were performed at Johns Hopkins Hospital. 43 patients had pretransplant serum available. sCD30 was determined using a commercially available kit (human sCD30 Instant ELISA, Bender MedSystems, Burlingame, CA). Pre and post operative patient variables were collected and patients stratified into two groups: sCD30⬍20 (lowCD30) and ⬎20 (highCD30). Continuous variables were compared using ANOVA, dichotomous variables compared with Chi square, and actuarial survival was compared using long rank test. Results: highCD30 (n⫽26) and low CD30 (n⫽17) groups were similar in age, gender, and ischemic time. In the highCD30 group, a greater percentage of patients had pulmonary fibrosis and fewer had emphysema. Pa02/Fi02 ratio at 48hrs was significantly worse in the highCD30 group as compared to lowCD30 (p⫽0.003). Moreover, prolonged intubation and 90 day mortality was greater in the highCD30 group. Discharge pulmonary function and overall actuarial survival was not significantly different. Conclusion: This represents the first report of the use of sCD30 as a marker for early allograft function in human LTx. Pretransplant recipient sCD30 appears to be associated with early post transplant gas exchange, prolonged intubation, and early mortality.
38-OR
PRESENSITIZATION OF KIDNEY TRANSPLANT RECIPIENTS AGAINST MICA ANTIGENS IS ASSOCIATED WITH EARLY RENAL ALLOGRAFT REJECTION. Yizhou Zou,1 Gerhard Opelz,2 Caner Susal,2 Bernd Dohler,2 Peter Stastny.1 1Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA; 2Transplantation Immunology, University of Heidelberg, Heidelberg, Germany. MHC class I related chain A (MICA) antigens are polymorphic and we have previously shown that they can elicit antibody production in kidney transplant recipients. Although HLA matching improves the outcome of kidney transplantation, it is known that some kidney transplants fail despite such negative lymphocyte crossmatches, suggesting that other antigens might be targets for rejection. We sought to determine whether an immune response to MICA antigens might play a role in kidney allograft failure. Pre-transplantation sera from 1,910 recipients of deceased donor kidney transplants were tested for anti-MICA antibodies with Luminex flow cytometry in which single MICA antigens are attached to polystyrene microspheres. Antibodies against MICA alleles were detected in 217 of 1,910 patients (11.4%). One-year graft survival rate was 88.3 ⫾2.2% in recipients with anti-MICA antibodies as compared to a 93.0⫾0.6% in recipients without MICA antibodies (P⫽0.014). Among recipients of first kidney transplants, the survival rate was even lower in MICA antibodypositive patients (87.8⫾2.4%) as compared to MICA antibody-negative recipients (93.5⫾0.6, p⫽0.005). Additionally, among 326 recipients who received 0 or 1 HLA-A⫹B⫹DR mismatch, the recipients with sensitization against MICA had a poorer allograft survival, comparing those without such antibodies (83.2⫾5.8% vs. 95.1⫾1.3, p⫽0.002). We conclude that presensitization of kidney transplant recipients against MICA antigens is associated with an increased graft loss and might be particularly important in recipients receiving organs from HLA well-matched donors.