Related Experiment Videos
Preliminary report: dramatic rise in renal allograft failure rate
A W Harmer1, S P Rigden, C G Koffman
1Department of Molecular Immunogenetics, Guy's Hospital, London, UK.
Lancet (London, England)
|May 19, 1990
Summary
A newly identified IgM antibody against epithelial cells (AEC) significantly correlated with kidney transplant rejection in children. Plasma exchange showed promise in saving grafts in AEC-positive patients, prompting a suspension of pediatric transplants pending further investigation.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- A significant decline in 1-year renal allograft survival was observed at Guy's Hospital paediatric transplant unit in 1989, dropping from 80% to 48%.
- While patients were negative for HLA antibodies, a subset tested positive for a specific IgM antibody against epithelial cells (AEC).
Purpose of the Study:
- To investigate the role of the newly identified antibody against epithelial cells (AEC) in pediatric kidney transplant failure.
- To evaluate the efficacy of plasma exchange in managing AEC-positive transplant recipients.
Main Methods:
- Retrospective analysis of pediatric renal allograft recipients.
- Detection of IgM antibody against epithelial cells (AEC) via serological testing.
- Comparison of graft survival rates between AEC-positive and AEC-negative patients.
- Assessment of treatment outcomes, including plasma exchange.
Main Results:
- Ten out of 21 pediatric patients were positive for AEC.
- AEC-positive patients received 12 grafts, with 9 lost and 3 salvaged by plasma exchange.
- AEC-negative patients received 11 grafts, with 3 lost (2 due to thrombosis).
- A highly significant correlation was found between AEC presence and graft rejection.
- Similar graft failures linked to AEC were observed in adult recipients at multiple institutions.
Conclusions:
- The presence of IgM antibody against epithelial cells (AEC) is strongly associated with renal allograft rejection in pediatric kidney transplant recipients.
- Plasma exchange may be a viable treatment to salvage grafts in AEC-positive patients.
- The apparent spread of AEC suggests a potential infectious etiology, warranting further investigation.
- Pediatric kidney transplants were suspended pending identification of the cause of AEC and its associated graft failures.