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Microchimerism and rejection in clinical transplantation
E T Elwood1, C P Larsen, D H Maurer
1Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Lancet (London, England)
|May 10, 1997
Summary
Donor cell persistence after organ transplant varies over time. Detecting microchimerism with a single post-transplant blood test may not guide individual patient care effectively.
Area of Science:
- Immunology
- Transplantation Science
- Molecular Biology
Background:
- Haemopoietic microchimerism is observed in solid-organ transplant recipients.
- It is hypothesized to be crucial for developing and maintaining immunological tolerance.
- This study investigates the link between donor cell persistence and clinical outcomes.
Purpose of the Study:
- To prospectively correlate donor cell persistence with clinical outcomes in kidney, kidney-pancreas, and liver transplant recipients.
- To assess the significance of microchimerism in post-transplant immunological responses.
Main Methods:
- Donor cells in recipient peripheral blood were tracked using a nested PCR technique targeting donor MHC HLA DR genes.
- Samples were collected at 3 days, and 1, 3, 6, and 12 months post-transplantation.
- Pre-transplant samples were used as negative controls; 25 liver, 13 kidney-pancreas, and 17 kidney recipients were analyzed.
Main Results:
- Donor DNA was detected in 80% of recipients at 3 days, decreasing to 32% at 12 months.
- Detection of donor DNA varied significantly over time within individuals.
- No significant difference in rejection episodes was observed between patients with and without detectable microchimerism.
Conclusions:
- A substantial proportion of transplant recipients exhibit persistent donor class II DNA for up to a year.
- Pre-transplant blood samples are essential to prevent false-positive results.
- The temporal variability of microchimerism suggests single post-transplant analyses may be insufficient for clinical decision-making.