Improved Long-Term Survival in Kidney Transplant Recipients with Donor-Specific HLA Antibodies After Mycophenolic Acid Escalation. 2014

Lorita M Rebellato, and Karen Parker, and Matthew J Everly, and Kimberly P Briley, and William Kendrick, and Scott Kendrick, and Carl E Haisch, and Paul I Terasaki, and Paul Bolin

The development of donor specific antibodies (DSA) post transplant has been associated with chronic rejection and graft failure. In a longitudinal study, we have shown that increases in DSA precede rejection by months, thus allowing time for intervention. We hypothesized that mycophenolic acid (MPA) dose increases may reduce and/or stabilize DSA strength and also preserve renal function. Thirty stable DSA positive kidney transplant recipients participated in this Institutional Review Board approved, exploratory, open-label, single center study to assess the efficacy of MPA dose escalation in patients with DSA. MPA escalation was well tolerated and most patients were able to take higher doses for at least two years (duration of the study). In addition, MPA escalation is safe and participants had no significant side effects such as cytomegalovirus and BK infections. Long-term allograft survival of the MPA escalation group was superior when compared with the control group (p = 0.018). This pilot study indicates that escalation of MPA is safe and may stabilize DSA. In addition, five-year follow up demonstrates improved long-term survival with MPA escalation compared with DSA positive recipients receiving the standard of care. Additional studies using larger cohorts are warranted.

UI MeSH Term Description Entries
D007166 Immunosuppressive Agents Agents that suppress immune function by one of several mechanisms of action. Classical cytotoxic immunosuppressants act by inhibiting DNA synthesis. Others may act through activation of T-CELLS or by inhibiting the activation of HELPER CELLS. While immunosuppression has been brought about in the past primarily to prevent rejection of transplanted organs, new applications involving mediation of the effects of INTERLEUKINS and other CYTOKINES are emerging. Immunosuppressant,Immunosuppressive Agent,Immunosuppressants,Agent, Immunosuppressive,Agents, Immunosuppressive
D007518 Isoantibodies Antibodies from an individual that react with ISOANTIGENS of another individual of the same species. Alloantibodies
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009173 Mycophenolic Acid Compound derived from Penicillium stoloniferum and related species. It blocks de novo biosynthesis of purine nucleotides by inhibition of the enzyme inosine monophosphate dehydrogenase (IMP DEHYDROGENASE). Mycophenolic acid exerts selective effects on the immune system in which it prevents the proliferation of T-CELLS, LYMPHOCYTES, and the formation of antibodies from B-CELLS. It may also inhibit recruitment of LEUKOCYTES to sites of INFLAMMATION. Cellcept,Mycophenolate Mofetil,Mycophenolate Mofetil Hydrochloride,Mycophenolate Sodium,Mycophenolic Acid Morpholinoethyl Ester,Myfortic,RS 61443,RS-61443,Sodium Mycophenolate,Mofetil Hydrochloride, Mycophenolate,Mofetil, Mycophenolate,Mycophenolate, Sodium,RS61443
D009657 North Carolina State bounded on the north by Virginia, on the east and Southeast by the Atlantic Ocean, on the south by Georgia and South Carolina, and on the west by Tennessee.
D005260 Female Females
D006084 Graft Rejection An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. Transplant Rejection,Rejection, Transplant,Transplantation Rejection,Graft Rejections,Rejection, Graft,Rejection, Transplantation,Rejections, Graft,Rejections, Transplant,Rejections, Transplantation,Transplant Rejections,Transplantation Rejections
D006085 Graft Survival The survival of a graft in a host, the factors responsible for the survival and the changes occurring within the graft during growth in the host. Graft Survivals,Survival, Graft,Survivals, Graft
D006648 Histocompatibility The degree of antigenic similarity between the tissues of different individuals, which determines the acceptance or rejection of allografts. HLA Incompatibility,Histoincompatibility,Human Leukocyte Antigen Incompatibility,Immunocompatibility,Tissue Compatibility,Compatibility, Tissue,HLA Incompatibilities,Histocompatibilities,Histoincompatibilities,Immunocompatibilities,Incompatibility, HLA,Tissue Compatibilities

Related Publications

Lorita M Rebellato, and Karen Parker, and Matthew J Everly, and Kimberly P Briley, and William Kendrick, and Scott Kendrick, and Carl E Haisch, and Paul I Terasaki, and Paul Bolin
March 2007, Pediatric transplantation,
Lorita M Rebellato, and Karen Parker, and Matthew J Everly, and Kimberly P Briley, and William Kendrick, and Scott Kendrick, and Carl E Haisch, and Paul I Terasaki, and Paul Bolin
September 2012, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons,
Lorita M Rebellato, and Karen Parker, and Matthew J Everly, and Kimberly P Briley, and William Kendrick, and Scott Kendrick, and Carl E Haisch, and Paul I Terasaki, and Paul Bolin
February 2018, Transplant immunology,
Lorita M Rebellato, and Karen Parker, and Matthew J Everly, and Kimberly P Briley, and William Kendrick, and Scott Kendrick, and Carl E Haisch, and Paul I Terasaki, and Paul Bolin
January 2018, Clinical journal of the American Society of Nephrology : CJASN,
Lorita M Rebellato, and Karen Parker, and Matthew J Everly, and Kimberly P Briley, and William Kendrick, and Scott Kendrick, and Carl E Haisch, and Paul I Terasaki, and Paul Bolin
December 1992, Transplantation proceedings,
Lorita M Rebellato, and Karen Parker, and Matthew J Everly, and Kimberly P Briley, and William Kendrick, and Scott Kendrick, and Carl E Haisch, and Paul I Terasaki, and Paul Bolin
December 1993, Transplantation proceedings,
Lorita M Rebellato, and Karen Parker, and Matthew J Everly, and Kimberly P Briley, and William Kendrick, and Scott Kendrick, and Carl E Haisch, and Paul I Terasaki, and Paul Bolin
December 2022, Transplant immunology,
Lorita M Rebellato, and Karen Parker, and Matthew J Everly, and Kimberly P Briley, and William Kendrick, and Scott Kendrick, and Carl E Haisch, and Paul I Terasaki, and Paul Bolin
March 2011, Pediatric transplantation,
Lorita M Rebellato, and Karen Parker, and Matthew J Everly, and Kimberly P Briley, and William Kendrick, and Scott Kendrick, and Carl E Haisch, and Paul I Terasaki, and Paul Bolin
August 2018, Pediatric transplantation,
Lorita M Rebellato, and Karen Parker, and Matthew J Everly, and Kimberly P Briley, and William Kendrick, and Scott Kendrick, and Carl E Haisch, and Paul I Terasaki, and Paul Bolin
August 2016, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons,
Copied contents to your clipboard!