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10.1016/j.kint.2016.12.024

http://scihub22266oqcxt.onion/10.1016/j.kint.2016.12.024
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suck abstract from ncbi


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pmid28274484      Kidney+Int 2017 ; 92 (1): 201-13
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  • Post-transplant peripheral blood donor-specific IFN-? ELISPOT assays differentiates risk of subclinical rejection and de novo donor-specific alloantibodies in kidney transplant recipients #MMPMID28274484
  • Crespo E; Cravedi P; Martorell J; Luque S; Melilli E; Cruzado JM; Jarque M; Meneghini M; Manonelles A; Donadei C; Lloberas N; Gomà M; Grinyó JM; Heeger P; Bestard O
  • Kidney Int 2017[Jul]; 92 (1): 201-13 PMID28274484show ga
  • Noninvasive diagnosis of kidney allograft inflammation in transplant recipients with stable graft function (subclinical rejection) could permit more effective therapy and prevent later development of de novo anti-donor HLA antibodies and/or graft dysfunction. Here we tested whether quantifying post-transplant donor-specific alloreactive T cells by IFN-? ELISPOT assay noninvasively detects subclinical T-cell mediated rejection and/or predicts development of anti-donor HLA antibodies. Using an initial cross-sectional cohort of 60 kidney transplant patients with six-month surveillance biopsies, we found that negative ELISPOT assays accurately ruled out the presence of subclinical T cell mediated rejection. These results were validated using a distinct prospective cohort of 101 patients where donor specific IFN-? ELISPOT results at both three- and six-months post-transplant significantly differentiated patients with subclinical T cell mediated rejection at six-month, independent of other clinical variables (odds ratio 0.072, 95% confidence interval 0.008-0.653). The post-transplant donor-specific IFN-? ELISPOT results independently associated with subsequent development of significant anti-donor HLA antibodies (0.085, 0.008-0.862) and with significantly worse two-year function (estimated glomerular filtration rate) compared to patients with a negative test. Thus, post-transplant immune monitoring by donor-specific IFN-? ELISPOT can assess risk for developing subclinical T cell mediated rejection and anti-donor HLA antibodies, potentially limiting the need for surveillance biopsies. Our study provides a guide for individualizing immunosuppression to improve post-transplant outcomes.
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