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Long-term Persistence of Allosensitization After Islet Allograft Failure
Paola Rios1, David Baidal1,2, Joana Lemos1
1Diabetes Research Institute (DRI) and Clinical Cell Transplant Program, University of Miami Miller School of Medicine, Miami, FL.
Transplantation
|January 22, 2021
Summary
Allosensitization after islet transplantation graft failure can persist for up to 15 years, impacting future transplant eligibility. This highlights the importance of monitoring immune responses post-immunosuppression withdrawal in islet transplant recipients.
Area of Science:
- Immunology
- Transplantation Science
- Endocrinology
Background:
- Allosensitization is a known complication after immunosuppression withdrawal in islet transplantation (ITx).
- The duration of allosensitization persistence following graft failure in ITx recipients remains largely unknown.
Purpose of the Study:
- To evaluate the persistence of allosensitization after graft failure in islet transplantation recipients.
- To assess the impact of immunosuppression withdrawal on the development and duration of allosensitization.
Main Methods:
- A cohort of 35 type 1 diabetes patients who underwent ITx was evaluated.
- Patients were categorized into those with graft failure (ITx alone or ITx with stem cells) and those with persistent graft function.
- Panel-reactive antibody (PRA) levels were measured yearly for up to 1 year post-graft failure and annually thereafter.
Main Results:
- In ITx alone recipients with graft failure, 61% were PRA-positive at 6 years, and 46% developed donor-specific antibodies (DSA).
- Allosensitization persisted for 7-15 years in ITx alone recipients.
- In ITx with stem cell recipients, 75% showed persistent cPRA and DSA positivity for 15 years.
Conclusions:
- The majority of ITx recipients (77%) become allosensitized after discontinuing immunosuppression.
- Allosensitization can persist for up to 15 years, posing clinical challenges for subsequent transplants.
- Monitoring immune sensitization is crucial for managing ITx recipients post-immunosuppression.
