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Clinical Significance of Alloantibodies in Hand Transplantation: A Multicenter Study
Karolinska Inst, Karolinska Univ Hosp, Dept Transplantat Surg, Div Transplantat Surg,CLINTEC, Stockholm, Sweden;Columbia Univ, Dept Med, Columbia Ctr Translat Immunol, Med Ctr, New York, NY USA.
Karolinska Inst, Karolinska Univ Hosp, Dept Transplantat Surg, Div Transplantat Surg,CLINTEC, Stockholm, Sweden.
Karolinska Inst, Karolinska Univ Hosp, Dept Transplantat Surg, Div Transplantat Surg,CLINTEC, Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.ORCID iD: 0000-0001-8623-0939
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2019 (English)In: Transplantation, ISSN 0041-1337, E-ISSN 1534-6080, Vol. 103, no 10, p. 2173-2182Article in journal (Refereed) Published
Abstract [en]

Background. Donor-specific antibodies (DSAs) have a strong negative correlation with long-term survival in solid organ transplantation. Although the clinical significance of DSA and antibody-mediated rejection (AMR) in upper extremity transplantation (UET) remains to be established, a growing number of single-center reports indicate their presence and potential clinical impact. Methods. We present a multicenter study assessing the occurrence and significance of alloantibodies in UET in reference to immunological parameters and functional outcome. Results. Our study revealed a high prevalence and early development of de novo DSA and non-DSA (43%, the majority detected within the first 3 postoperative y). HLA class II mismatch correlated with antibody development, which in turn significantly correlated with the incidence of acute cellular rejection. Cellular rejections preceded antibody development in almost all cases. A strong correlation between DSA and graft survival or function cannot be statistically established at this early stage but a correlation with a lesser outcome seems to emerge. Conclusions. While the phenotype and true clinical effect of AMR remain to be better defined, the high prevalence of DSA and the correlation with acute rejection highlight the need for optimizing immunosuppression, close monitoring, and the relevance of an HLA class II match in UET recipients.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS , 2019. Vol. 103, no 10, p. 2173-2182
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Surgery
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URN: urn:nbn:se:uu:diva-406474DOI: 10.1097/TP.0000000000002650ISI: 000509555300037PubMedID: 30817406OAI: oai:DiVA.org:uu-406474DiVA, id: diva2:1412909
Available from: 2020-03-09 Created: 2020-03-09 Last updated: 2020-03-09Bibliographically approved

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