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ProjectsChronic Rejection RegistryBackground
Clinical Usefulness of Antibodies POST TransplantationThe purpose of a Workshop study should be to solve something important
which cannot easily be solved by a single individual or center. A good
example is the 13th Workshop study in which HLA antibodies identified
prospectively were associated with immunological chronic rejection (Am
J Transplant 4:438-443, 2004). Examination of the Table in that study
will show that it was only by summation of the results of different centers,
that significant results were obtained. We propose to build on this structure
and take several new steps not possible previously. 14th IHIWS Workshop Chronic Rejection Study PlanPurpose: To show that patients who have HLA antibodies post transplantation will have chronic graft failure. Rationale: In the 13th Workshop, a prospective study showed that those patients who had HLA antibodies had a significantly higher graft failure rate than those who did not have HLA antibodies (Terasaki, Ozawa, Am J Transplantation 4:448, 2004). With the recent availability of improved antibody detection methods and new ability to detect anti- MIC antibodies, we wish to demonstrate conclusively, in a larger series of patients, that the presence of HLA and MIC antibodies does indeed predict chronic graft failure. Since only about 5% of functioning patients can be expected to fail in one year, it is difficult for a single center to obtain a clear answer to this question. Significance: If it is shown that patients with HLA antibodies fail at a higher rate, clinicians will be convinced to monitor their patients and to intervene with other immunosuppression to eliminate the antibodies. Also, among those who have no antibodies, immunosuppression might be reduced. Plan: The study plan is again rather simple: take a snapshot of all patients with currently functioning grafts who had been transplanted at least 6 months previously. Bleed from July 2004 to December, 2004 to determine who has HLA and MIC antibodies. Then, one year later, see if those who had antibodies have failed at a greater rate than those who did not have antibodies. It is important to note that only about 5% of grafts will be expected to fail in one year. This is the reason a large scale collaborative study is needed since at any given center the number of failures in one year would be too small to reach any conclusions. Although we will concentrate on kidney, any organs such as heart, liver and lungs will be included (since they have the same overall risk of 5% per year). In addition, attempts will be made to identify non-HLA antibodies which also are postulated to produce chronic rejection. This will be done by serum exchange. Protocol. NOTE Please start collecting sera immediately. If your review board
rejects the proposal, you can then throw out the sera. Chairperson:
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