Seguimiento inmunológico después de trasplante renal: una propuesta para la práctica clínica en Colombia

Melissa Andrea Ortiz , Cristiam Mauricio Álvarez , Ana María Arrunátegui , Yazmin Rocío Arias , Adriana Villegas , .

Palabras clave: trasplante de riñón, isoanticuerpos, rechazo de injerto

Resumen

El daño del injerto es un proceso multifactorial que se inicia tempranamente después de la mayoría de los trasplantes de donantes sin HLA idéntico. Puede deberse a las comorbilidades del receptor, al estado del donante, al tiempo de isquemia, y al fenómeno de isquemia y reperfusión, entre otros, condiciones que inducen factores metabólicos e inmunológicos que finalmente desembocan en la disfunción del injerto. Sin embargo, entre el momento del trasplante y la aparición de los signos y síntomas existe un periodo que puede tardar semanas o años. Por ello, después del trasplante renal, es importante hacer un seguimiento racional que incluya la evaluación clínica y permita anticiparse al daño inmunológico del injerto. En este ensayo se propone un algoritmo de seguimiento del injerto renal después del trasplante.

Descargas

Los datos de descargas todavía no están disponibles.

Referencias bibliográficas

Sá H, Leal R, Rosa MS. Renal transplant immunology in the last 20 years: A revolution towards graft and patient survival improvement. Int Rev Immunol. 2017;36:182-203. https://doi.org/10.1080/08830185.2016.1225300

Locke JE, Zachary AA, Warren DS, Segev DL, Houp JA, Montgomery RA, et al. Proinflammatory events are associated with significant increases in breadth and strength of HLA-specific antibody. Am J Transplant. 2009;9:2136-9. https://doi.org/10.1111/j.1600-6143.2009.02764.x

Haas M, Loupy A, Lefaucheur C, Roufosse C, Glotz D, Seron D, et al. The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials. Am J Transplant. 2018;18:293-307. https://doi.org/10.1111/ajt.14625

Djamali A, Kaufman DB, Ellis TM, Zhong W, Matas A, Samaniego M. Diagnosis and management of antibody-mediated rejection: Current status and novel approaches. Am J Transplant. 2014;14:255-71. https://doi.org/10.1111/ajt.12589

Gosset C, Viglietti D, Rabant M, Vérine J, Aubert O, Glotz D, et al. Circulating donor-specific anti-HLA antibodies are a major factor in premature and accelerated allograft fibrosis. Kidney Int. 2017;92:729-42. https://doi.org/10.1016/j.kint.2017.03.033

Cioni M, Nocera A, Innocente A, Tagliamacco A, Trivelli A, Basso S, et al. De novo donorspecific HLA antibodies developing early or late after transplant are associated with the same risk of graft damage and loss in nonsensitized kidney recipients. J Immunol Res. 2017;2017:1747030. https://doi.org/10.1155/2017/1747030

Mengel M, Sis B, Haas M, Colvin RB, Halloran PF, Racusen LC, et al. Banff 2011 meeting report: New concepts in antibody-mediated rejection. Am J Transplant. 2012;12:563-70. https://doi.org/10.1111/j.1600-6143.2011.03926.x

Colvin RB, Smith RN. Antibody-mediated organ-allograft rejection. Nat Rev Immunol. 2005;5:807-17. https://doi.org/10.1038/nri1702

Wiebe C, Gibson IW, Blydt-Hansen TD, Karpinski M, Ho J, Storsley LJ, et al. Evolution and clinical pathologic correlations of de novo donor-specific HLA antibody post kidney transplant. Am J Transplant. 2012;12:1157-67. https://doi.org/10.1111/j.1600-6143.2012.04013.x

Sis B, Halloran PF. Endothelial transcripts uncover a previously unknown phenotype: C4dnegative antibody-mediated rejection. Curr Opin Organ Transplant. 2010;15:42-8. https://doi.org/10.1097/MOT.0b013e3283352a50

Wiebe C, Gibson IW, Blydt-Hansen TD, Pochinco D, Birk PE, Ho J, et al. Rates and determinants of progression to graft failure in kidney allograft recipients with de novo donorspecific antibody. Am J Transplant. 2015;15:2921-30. https://doi.org/10.1111/ajt.13347

Hidalgo LG, Campbell PM, Sis B, Einecke G, Mengel M, Chang J, et al. De novo donorspecific antibody at the time of kidney transplant biopsy associates with microvascular pathology and late graft failure. Am J Transplant. 2009;9:2532-41. https://doi.org/10.1111/j.1600-6143.2009.02800.x

Racusen LC, Haas M. Antibody-mediated rejection in renal allografts: Lessons from pathology. Clin J Am Soc Nephrol. 2006;1:415-20. https://doi.org/10.2215/CJN.01881105

Haas M, Sis B, Racusen LC, Solez K, Glotz D, Colvin RB, et al. Banff 2013 meeting report: Inclusion of C4d-negative antibody-mediated rejection and antibody-associated arterial lesions. Am J Transplant. 2014;14: 272-83. https://doi.org/10.1111/ajt.12590

Tait BD, Süsal C, Gebel HM, Nickerson PW, Zachary AA, Claas FHJ, et al. Consensus guidelines on the testing and clinical management issues associated with HLA and Non-HLA antibodies in transplantation. Transplantation. 2013;95:19-47. https://doi.org/10.1097/TP.0b013e31827a19cc

Bestard O, Cravedi P. Monitoring alloimmune response in kidney transplantation. J Nephrol. 2017;30:187-200. https://doi.org/10.1007/s40620-016-0320-7

Billen EVA, Christiaans MHL, Lee J, van den Berg-Loonen EM. Donor-directed HLA antibodies before and after transplantectomy detected by the luminex single antigen assay. Transplantation. 2009;87:563-9. https://doi.org/10.1097/TP.0b013e3181949e37

Huber L, Lachmann N, Niemann M, Naik M, Liefeldt L, Glander P, et al. Pretransplant virtual PRA and long-term outcomes of kidney transplant recipients. Transpl Int. 2015;28:710-9. https://doi.org/10.1111/tri.12533

Ercilla MG, Martorell J. Estudio inmunológico de la pareja donante-receptor. Nefrología. 2010;30:60-70. https://doi.org/10.3265/Nefrologia.pre2010.Nov.10692

Tambur AR, Campbell P, Claas FH, Feng S, Gebel HM, Jackson AM, et al. Sensitization in transplantation: Assessment of Risk (STAR) 2017 Working Group Meeting Report. Am J Transplant. 2018;18:1604-14. https://doi.org/10.1111/ajt.14752

Crespo E, Bestard O. Biomarkers to assess donor-reactive T-cell responses in kidney transplant patients. Clin Biochem. 2016;49:329-37. https://doi.org/10.1016/j.clinbiochem.2015.08.010

Grenzi PC, Campos ÉF, Silva HT, Felipe CR, Franco MF, Soares MF, et al. Post-transplant soluble CD30 levels are associated with early subclinical rejection in kidney transplantation. Transpl Immunol. 2015;32:61-5. https://doi.org/10.1016/j.trim.2015.02.004

Süsal C, Fichtner A, Tönshoff B, Mehrabi A, Zeier M, Morath C. Clinical relevance of HLA antibodies in kidney transplantation: Recent data from the Heidelberg Transplant Center and the Collaborative Transplant Study. J Immunol Res. 2017;2017:5619402. https://doi.org/10.1155/2017/5619402

Aubert O, Loupy A, Hidalgo L, van Huyen JPD, Higgins S, Viglietti D, et al. Antibody-mediated rejection due to preexisting versus de novo donor-specific antibodies in kidney allograft recipients. J Am Soc Nephrol. 2017;28:1912-23. https://doi.org/10.1681/ASN.2016070797

Mehra NK, Baranwal AK. Clinical and immunological relevance of antibodies in solid organ transplantation. Int J Immunogenet. 2016;43:351-68. https://doi.org/10.1111/iji.12294

Morath C, Opelz G, Zeier M, Süsal C. Clinical relevance of HLA antibody monitoring after kidney transplantation. J Immunol Res. 2014;2014:845040. https://doi.org/10.1155/2014/845040

Halloran PF, De Freitas DG, Einecke G, Famulski KS, Hidalgo LG, Mengel M, et al. The molecular phenotype of kidney transplants: Personal viewpoint. Am J Transplant. 2010;10:2215-22. https://doi.org/10.1111/j.1600-6143.2010.03267.x

Roedder S, Sigdel T, Salomonis N, Hsieh S, Dai H, Bestard O, et al. The kSORT assay to detect renal transplant patients at high risk for acute rejection: Results of the multicenter AART Study. PLoS Med. 2014;11. https://doi.org/10.1371/journal.pmed.1001759

Zhang Q, Reed EF. The importance of non-HLA antibodies in transplantation. Nat Rev Nephrol. 2016;12:484-95. https://doi.org/10.1038/nrneph.2016.88

Pearl MH, Zhang Q, Palma-Diaz MF, Grotts J, Rossetti M, Elashoff D, et al. Angiotensin II type 1 receptor antibodies are associated with inflammatory cytokines and poor clinical outcomes in pediatric kidney transplantation. Kidney Int. 2018;93:260-9. https://doi.org/10.1016/j.kint.2017.06.034

Cómo citar
1.
Ortiz MA, Álvarez CM, Arrunátegui AM, Arias YR, Villegas A. Seguimiento inmunológico después de trasplante renal: una propuesta para la práctica clínica en Colombia. biomedica [Internet]. 1 de septiembre de 2020 [citado 28 de marzo de 2024];40(3):479-86. Disponible en: https://revistabiomedica.org/index.php/biomedica/article/view/5092

Algunos artículos similares:

Publicado
2020-09-01
Sección
Ensayo

Métricas

Estadísticas de artículo
Vistas de resúmenes
Vistas de PDF
Descargas de PDF
Vistas de HTML
Otras vistas
Crossref Cited-by logo
QR Code