[PMID]: | 28665894 |
[Au] Autor: | OʼLeary JG; Demetris AJ; Philippe A; Freeman R; Cai J; Heidecke H; Smith C; Hart B; Jennings LW; Catar R; Everly M; Klintmalm GB; Dragun D |
[Ad] Endereço: | 1 Annette C. & Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX. 2 Department of Pathology, University of Pittsburgh, Pittsburg, PA. 3 Department of Nephrology and Critical Care Medicine, Charité, Berlin, Germany. 4 Terasaki Foundation Laboratory, Los Angeles, CA. 5 Celltrend, Luckenwalde, Germany. |
[Ti] Título: | Non-HLA Antibodies Impact on C4d Staining, Stellate Cell Activation and Fibrosis in Liver Allografts. |
[So] Source: | Transplantation;101(10):2399-2409, 2017 Oct. |
[Is] ISSN: | 1534-6080 |
[Cp] País de publicação: | United States |
[La] Idioma: | eng |
[Ab] Resumo: | BACKGROUND: Recent data have shown an increased risk for rejection, fibrosis progression, and death in liver transplantation (LT) recipients with preformed or de novo HLA donor-specific alloantibodies (DSA). However, the role of non-HLA autoantibodies and the interaction between HLA DSA and non-HLA autoantibodies remains uncharacterized. METHODS: We analyzed 1269 primary LT recipients from 1 of 2000 to 4 of 2009 with known HLA DSA status for angiotensin II type-1 receptor and endothelin-1 type A receptor autoantibodies pre-LT, and year 1 post-LT. RESULTS: Preformed non-HLA autoantibodies alone did not impact outcomes. In multivariable modeling, the combination of preformed non-HLA autoantibodies and HLA-DSA were associated with an increased risk for death (hazard ratio [HR], 1.66; P = 0.02) especially if the HLA DSA was of the IgG3 subclass (HR, 2.28; P = 0.01). A single de novo non-HLA autoantibody was associated with an increased risk for T cell-mediated rejection or antibody-mediated rejection (68% vs 41%, P = 0.01) and fibrosis progression (HR, 1.84; P = 0.02). Biopsies with de novo non-HLA autoantibodies revealed a new sinusoidal C4d staining pattern when compared with HLA DSA (71% vs 3%; P < 0.001). Liver sinusoidal endothelial cell activation and stellate cell activation was increased in patients with non-HLA autoantibodies in the location of C4d positivity. CONCLUSIONS: A non-HLA autoantibody combined with a preformed HLA DSA is associated with an increased mortality risk. Isolated de novo anti-angiotensin II type-1 receptor and anti-endothelin-1 type A receptor autoantibodies are associated with an increased risk of rejection and fibrosis progression. The novel location of C4d staining in proximity to liver sinusoidal endothelial cell capillarization and stellate cell activation demonstrates allograft injury in proximity to non-HLA autoantibody binding. |
[Mh] Termos MeSH primário: |
Autoanticorpos/sangue Complemento C4b/imunologia Rejeição de Enxerto/imunologia Antígenos HLA/imunologia Células Estreladas do Fígado/imunologia Isoanticorpos/sangue Cirrose Hepática/imunologia Transplante de Fígado/efeitos adversos Fragmentos de Peptídeos/imunologia Receptor Tipo 1 de Angiotensina/imunologia Receptor de Endotelina A/imunologia
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[Mh] Termos MeSH secundário: |
Adulto Aloenxertos Biópsia Feminino Rejeição de Enxerto/diagnóstico Células Estreladas do Fígado/patologia Seres Humanos Estimativa de Kaplan-Meier Cirrose Hepática/diagnóstico Cirrose Hepática/mortalidade Transplante de Fígado/mortalidade Masculino Meia-Idade Estudos Retrospectivos Fatores de Risco Fatores de Tempo Resultado do Tratamento
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[Pt] Tipo de publicação: | COMPARATIVE STUDY; JOURNAL ARTICLE |
[Nm] Nome de substância:
| 0 (AGTR1 protein, human); 0 (Autoantibodies); 0 (HLA Antigens); 0 (Isoantibodies); 0 (Peptide Fragments); 0 (Receptor, Angiotensin, Type 1); 0 (Receptor, Endothelin A); 80295-50-7 (Complement C4b); 80295-52-9 (complement C4d) |
[Em] Mês de entrada: | 1710 |
[Cu] Atualização por classe: | 171016 |
[Lr] Data última revisão:
| 171016 |
[Sb] Subgrupo de revista: | IM |
[Da] Data de entrada para processamento: | 170701 |
[St] Status: | MEDLINE |
[do] DOI: | 10.1097/TP.0000000000001853 |
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