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The influence of immunosuppressive agents on the risk of de novo donor-specific HLA antibody production in solid organ transplant recipients.

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dc.contributor.author O'Leary, Jacqueline G.
dc.contributor.author Samaniego, Millie
dc.contributor.author Crespo Barrio, Marta
dc.contributor.author Potena, Luciano
dc.contributor.author Zeevi, Adriana
dc.contributor.author Djamali, Arjang
dc.contributor.author Cozzi, Emanuele
dc.date.accessioned 2016-01-25T08:19:42Z
dc.date.available 2016-01-25T08:19:42Z
dc.date.issued 2016
dc.identifier.citation OʼLeary JG, Samaniego M, Barrio MC, Potena L, Zeevi A, Djamali A. et al. The Influence of Immunosuppressive Agents on the Risk of De Novo Donor-Specific HLA Antibody Production in Solid Organ Transplant Recipients. Transplantation. 2016 Jan;100(1):39-53. doi: 10.1097/TP.0000000000000869.
dc.identifier.issn 0041-1337
dc.identifier.uri http://hdl.handle.net/10230/25643
dc.description.abstract Production of de novo donor-specific antibodies (dnDSA) is a major risk factor for acute and chronic antibody-mediated rejection and graft loss after all solid organ transplantation. In this article, we review the data available on the risk of individual immunosuppressive agents and their ability to prevent dnDSA production. Induction therapy with rabbit antithymocyte globulin may achieve a short-term decrease in dnDSA production in moderately sensitized patients. Rituximab induction may be beneficial in sensitized patients, and in abrogating rebound antibody response in patients undergoing desensitization or treatment for antibody-mediated rejection. Use of bortezomib for induction therapy in at-risk patients is of interest, but the benefits are unproven. In maintenance regimens, nonadherent and previously sensitized patients are not suitable for aggressive weaning protocols, particularly early calcineurin inhibitor withdrawal without lymphocyte-depleting induction. Early conversion to mammalian target of rapamycin inhibitor monotherapy has been reported to increase the risk of dnDSA formation, but a combination of mammalian target of rapamycin inhibitor and reduced-exposure calcineurin inhibitor does not appear to alter the risk. Early steroid therapy withdrawal in standard-risk patients after induction has no known dnDSA penalty. The available data do not demonstrate a consistent effect of mycophenolic acid on dnDSA production. Risk minimization for dnDSA requires monitoring of adherence, appropriate risk stratification, risk-based immunosuppression intensity, and prospective DSA surveillance.
dc.description.sponsorship J.G.O'L. has acted as a consultant and received speaker’s honoraria from Astellas and Novartis, Gilead, and Abbvie, and has received a grant from One Lambda Fisher Scientific. M.S. is a member of an advisory board for Sanofi, has received a grant and is chair of a data safety monitoring board for Alexion Pharmaceuticals, is a member of an advisory board and has received a grant from Millennium Pharmaceuticals, is a member of an advisory board and has received a grant from Genentech, and has received funding from NIH. M.C.B. has received public funding for research from the Spanish Ministry of Health and speaker's honoraria from Novartis, Astellas and Abbvie. L.P. has received speaker's honoraria from Novartis, Astellas, Biotest and grants from Novartis, Qiagen and Thermofisher. A.Z. has received grants from NIH and CSL Behring and received speaker's honoraria from One Lambda Fisher Scientific and CSL Behring. A.D. has received grants from NIH, BMS and Takeda-Millenium, and is a consultant for BMS and Sanofi. E.C. acted as a consultant for Novartis, Astellas, Alexion Pharmaceuticals and Biotest.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher Lippincott, Williams & Wilkins
dc.relation.ispartof Transplantation. 2016 Jan;100(1):39-53
dc.rights © 2015 Wolters Kluwer Health, Inc. All rights reserved. This is an openaccess article distributed under the terms of the http://creativecommonsattribution-noncommercial-noderivatives3.0license/, where it is permissible to download/nand share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subject.other Anticossos
dc.subject.other Immunosupressió
dc.title The influence of immunosuppressive agents on the risk of de novo donor-specific HLA antibody production in solid organ transplant recipients.
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1097/TP.0000000000000869
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion

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