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BMC Nephrology Nov 2020Kidney allograft survival continuously improved with introduction of novel immunosuppressants. However, also immunologically challenging transplants (blood group...
BACKGROUND
Kidney allograft survival continuously improved with introduction of novel immunosuppressants. However, also immunologically challenging transplants (blood group incompatibility and sensitized recipients) increase. Between 2006 and 2008, a new tailored immunosuppression scheme for kidney transplantation was implemented at the University Hospital in Zurich, together with an ABO-incompatible transplant program and systematic pre- and posttransplant anti-human leukocyte antigen (HLA) antibody screening by Luminex technology. This study retrospectively evaluated the results of this tailored immunosuppression approach with a particular focus on immunologically higher risk transplants.
METHODS
A total of 204 consecutive kidney transplantations were analyzed, of whom 14 were ABO-incompatible and 35 recipients were donor-specific anti-HLA antibodies (DSA) positive, but complement-dependent cytotoxicity crossmatch (CDC-XM) negative. We analyzed patient and graft survival, acute rejection rates and infectious complications in ABO-compatible versus -incompatible and in DSA positive versus negative patients and compared those with a historical control group.
RESULTS
Overall patient, death-censored allograft survival and non-death-censored allograft survival at 4 years were 92, 91 and 87%, respectively. We found that (1) there were no differences between ABO-compatible and -incompatible and between DSA positive and DSA negative patients concerning acute rejection rate and graft survival; (2) compared with the historical control group there was a significant decrease of acute rejection rates in sensitized patients who received an induction with thymoglobulin; (3) there was no increased rate of infection among the patients who received induction with thymoglobulin compared to no induction therapy.
CONCLUSIONS
We observed excellent overall mid-term patient and graft survival rates with our tailored immunosuppression approach. Induction with thymoglobulin was efficient and safe in keeping rejection rates low in DSA positive patients with a negative CDC-XM.
Topics: Adult; Antilymphocyte Serum; Autoantibodies; Basiliximab; Blood Group Incompatibility; Drug Therapy, Combination; Female; Graft Rejection; Graft Survival; HLA Antigens; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Renal Insufficiency; Retrospective Studies; Rituximab; Survival Analysis; Transplantation Immunology
PubMed: 33228545
DOI: 10.1186/s12882-020-02137-5 -
Journal of Veterinary Internal Medicine Jan 2021The performance of commercial point-of-care crossmatch (CM) tests compared to laboratory tube agglutination CM is unknown. Additionally, there is limited information...
BACKGROUND
The performance of commercial point-of-care crossmatch (CM) tests compared to laboratory tube agglutination CM is unknown. Additionally, there is limited information regarding CM incompatibility in ill dogs.
OBJECTIVES
To determine if point-of-care major CM methods are accurate in detecting compatible and incompatible tests when compared to laboratory CM methods, and to identify factors associated with CM incompatibility in dogs.
ANIMALS
Part 1 (prospective) included 63 client-owned dogs potentially requiring blood transfusion. Part 2 (retrospective) included all dogs from part 1, plus medical records of 141 dogs with major CM results.
METHODS
For part 1, major CM was performed using a tube agglutination assay (LAB-CM), a gel-based point-of-care test (GEL-CM), and an immunochromatographic point-of-care test (IC-CM). For part 2, medical record data were collected to determine rates of and risk factors for CM incompatibility.
RESULTS
Kappa agreement between the LAB-CM and GEL-CM methods could not be calculated due to a relative lack of incompatible results. Kappa agreement between the LAB-CM and IC-CM methods was 0.16 (95% confidence interval [CI] = 0-0.31, P = .007) indicating no agreement. The LAB-CM incompatibility in transfusion-naïve vs dogs that had a transfusion was 25% and 35%, (P = .3).
CONCLUSIONS AND CLINICAL IMPORTANCE
Compared to laboratory methods, point-of-care methods evaluated in our study lacked sensitivity for detecting incompatibilities. Dogs had similar rates of major CM incompatibility regardless of transfusion history. This suggests CM testing prior to transfusion be considered in all dogs however our study did not investigate clinical relevancy of incompatible LAB-CM.
Topics: Animals; Blood Group Incompatibility; Blood Grouping and Crossmatching; Critical Illness; Dog Diseases; Dogs; Point-of-Care Systems; Prospective Studies; Retrospective Studies
PubMed: 33336866
DOI: 10.1111/jvim.15983 -
American Journal of Primatology Jan 2020Pair housing is one of the most important components of behavioral management for caged macaques; however, it can result in aggression and injury if partners are...
Pair housing is one of the most important components of behavioral management for caged macaques; however, it can result in aggression and injury if partners are incompatible. Knowing when to proceed and when to stop social introductions can be challenging, and can have consequences for the partners. We examined whether behavior early in social introductions predicted success (i.e., partners remained cohoused with full contact for at least 28 days) in 724 female-female and 477 male-male rhesus macaque pairs. We took cage side one-zero focal observations on pairs during the first 2 days of full contact, recording social and aggressive behaviors. The majority of pairs (79.6% of female and 83.0% of male) were successful. The most common behaviors exhibited by pairs during these observations were maintaining proximity, tandem threats, and anxiety. Mounting was also relatively common in male pairs. Grooming and close social contact (e.g., touching) were not common in our study. Several behaviors observed on Day 1 significantly predicted pairing success. For females, these included proximity, tandem threat, rump present, mount, and groom. Day 1 predictors of success for male pairs included proximity, tandem threat, rump present, mount, and social contact. Fewer behaviors predicted success on Day 2. Maintaining proximity on Day 2 predicted success for both sexes, but tandem threat predicted success only for females. Behaviors that predicted incompatibility for females on Day 1 included displace, grimace, threat, bite, and other aggressive contacts. Day 1 predictors of separation for male pairs were displaced, grimace, and abnormal behavior. The only Day 2 behavior that correlated with incompatibility was grimace, which was predictive for males. Interestingly, aggression did not predict incompatibility for male pairs. Identifying behaviors exhibited by monkeys early in the pair introduction that are predictive of long-term compatibility can shape pairing decisions, reducing later stress and potential injury.
Topics: Aggression; Animal Husbandry; Animals; Behavior, Animal; Female; Housing, Animal; Macaca mulatta; Male; Social Behavior
PubMed: 31916274
DOI: 10.1002/ajp.23081 -
Transfusion Medicine Reviews Oct 2019Red blood cell (RBC) transfusion is a critical component of optimal management for a broad range of conditions. Regardless of the indication, pretransfusion testing is... (Review)
Review
Red blood cell (RBC) transfusion is a critical component of optimal management for a broad range of conditions. Regardless of the indication, pretransfusion testing is required to appropriately match RBC donors and recipients to provide immunologically compatible blood. Although this approach is effective in the vast majority of situations, occasionally, patients will inadvertently receive an incompatible RBC transfusion, which can result in a hemolytic transfusion reaction (HTR). In addition, patients with life-threatening anemia and a complex alloantibody profile, which precludes rapid procurement of compatible RBCs, may also receive incompatible RBCs, placing them at risk for an HTR. Despite the rarity of these clinical situations, when incompatible blood transfusion results in an HTR, the consequences can be devastating. In this review, we will explore the challenges associated with actively preventing and treating acute HTRs following incompatible RBC transfusion. In doing so, we will focus primarily on the role of complement, not only as a key player in HTRs, but also as a potential target for the prevention and treatment of HTRs.
Topics: Blood Group Incompatibility; Complement Activation; Complement System Proteins; Erythrocyte Transfusion; Erythrocytes; Humans; Isoantibodies; Isoantigens; Transfusion Reaction
PubMed: 31679762
DOI: 10.1016/j.tmrv.2019.09.006 -
Pediatric Nephrology (Berlin, Germany) Feb 2023There is increasing evidence of good short-term and medium-term outcomes of ABO incompatible (ABOi) and HLA incompatible (HLAi) kidney transplantation with...
BACKGROUND
There is increasing evidence of good short-term and medium-term outcomes of ABO incompatible (ABOi) and HLA incompatible (HLAi) kidney transplantation with pre-transplant positive crossmatches in paediatric practice. However, there remain concerns regarding the higher risks of infective complications and antibody-mediated rejections. The aim of our study is to show longer-term follow-up on all ABOi and HLAi paediatric kidney transplant recipients (pKTR) in the UK.
METHODS
Questionnaires specifying kidney transplant type, desensitisation requirement and kidney allograft function were sent to 13 paediatric nephrology centres that performed kidney transplantation in children and young people under 18 years of age who received an ABOi and/or HLAi transplant between 1 January 2006 and 31 December 2016. Patient and kidney allograft survival were compared between ABOi, HLAi and ABO/HLA compatible (ABOc/HLAc) groups.
RESULTS
Among 711 living donor kidney transplants performed in the UK, 23 were ABOi and 6 were HLAi. Patient survival was 87%, 100% and 96% in ABOi, HLAi and ABOc/HLAc groups, respectively, at median follow-up of 6.8 (3.6-14.0) years post-transplant. Death-censored kidney allograft survival was 100% in all 3 groups at last follow-up. There were no cases of primary non-function in ABOi or HLAi groups, but 2% in the ABOc/HLAc group. There was one reported case of Epstein-Barr viral-induced post-transplant lymphoproliferative disorder.
CONCLUSION
Longer term follow-up has shown that ABOi and HLAi kidney transplantation are feasible for pKTR where no compatible donors are available, and that minimising desensitisation should be achieved where possible. A higher resolution version of the Graphical abstract is available as Supplementary information.
Topics: Humans; Child; Adolescent; Kidney Transplantation; Graft Rejection; Retrospective Studies; Living Donors; Blood Group Incompatibility; United Kingdom; ABO Blood-Group System; Graft Survival
PubMed: 35695967
DOI: 10.1007/s00467-022-05583-5 -
Asian Journal of Transfusion Science 2022The need for an anti-human globulin (AHG) cross-match (XM) when the antibody screen (ABS) is negative is debatable and a matter of policy.
BACKGROUND
The need for an anti-human globulin (AHG) cross-match (XM) when the antibody screen (ABS) is negative is debatable and a matter of policy.
AIM
(1) To compare the outcomes of type and screen (T and S) method the AHG-XM in terms of posttransfusion alloimmunization and hemolytic reactions. (2) Calculation of XM transfusion ratio in both groups.
MATERIALS AND METHODS
The study included 200 patients undergoing elective cardiovascular surgery. Group I patients ( = 100) were issued packed red blood cell units after ABO and RhD typing, an ABS followed by an immediate spin XM (T and S protocol), while Group II ( = 100) patients by an AHG-XM. In Group II patients, if incompatibility was found, then an ABS and identification were performed. A posttransfusion ABS and a direct antiglobulin test (DAT) was done on the 4 day. The XM, ABS (3-cell panel) and DAT were done using the gel technique (Bio-Rad, Switzerland). Thus, the outcomes of T and S method the AHG-XM in terms of posttransfusion alloimmunization and hemolytic reactions was measured. The XM transfusion ratio was also calculated in both groups.
RESULTS
In each of Groups I and II, 99 patients (99%) were transfused. There was no significant difference between the two groups based on previous transfusion ( = 0.621) or combined history of transfusion and pregnancy ( = 1). In Group I, all the patients were negative for ABS. In Group II, an AHG-XM was incompatible for 1 patient (1%) due to anti-c and anti-E alloantibodies and had a history of pregnancy as well as transfusion. In both the groups, none of the patients had any adverse transfusion reaction and the posttransfusion ABS and DAT were negative.
CONCLUSION
ABS is a better tool than AHG-XM in detecting alloantibodies in patients having the previous history of transfusion and/or pregnancy.
PubMed: 36199399
DOI: 10.4103/ajts.AJTS_21_19 -
Translational Pediatrics Jun 2022Hyperbilirubinemia is the most common cause of neonatal hospitalization and, although it generally has a good prognosis, a significant percentage of neonatal patients...
BACKGROUND
Hyperbilirubinemia is the most common cause of neonatal hospitalization and, although it generally has a good prognosis, a significant percentage of neonatal patients maintain a high bilirubin level, which can lead to severe complications, including lifelong disability such as growth retardation, encephalopathy, autism and hearing impairment. The study of risk factors for neonatal hyperbilirubinemia has been controversial. Therefore, we evaluated the risk factors of neonatal hyperbilirubinemia using a meta-analysis.
METHODS
Relevant English and Chinese studies that discussed risk factors for neonatal hyperbilirubinemia were retrieved from the PubMed, EMBASE, Medline, Central, China National Knowledge Infrastructure (CNKI), Wanfang and China Science Digital Library (CSDL). The literature took newborns as the research object, set up a control group, and observed the relationship between exposure factors and neonatal hyperbilirubinemia. The combined effect size was expressed by odds ratio (OR) and 95% confidence interval (CI). The Chi-square test was used to test heterogeneity of the studies, and if it existed, subgroup analyses were used to explore the source of heterogeneity, and the random-effects model was selected for the combined analysis. The fixed-effects model was chosen for the combined analysis if there was no heterogeneity. Publication bias was assessed using Egger's test and funnel plot.
RESULTS
Risk factors for neonatal hyperbilirubinemia were exclusive breastfeeding (BF: OR =1.74, 95% CI: 1.42, 2.12, Z=5.43, P<0.00001); glucose-6-phosphate dehydrogenase deficiency (G6PD: OR =1.62, 95% CI: 1.44, 1.81, Z=8.39, P<0.00001); maternal-fetal ABO blood group incompatibility (OR =1.64, 95% CI: 1.42, 1.89, Z=6.75, P<0.00001); and preterm birth (PTB: OR =1.31, 95% CI: 1.17, 1.47, Z=4.60, P<0.00001); there was no heterogeneity or publication bias among the studies (BF: χ=5.34, P=0.25, I=25%; G6PD: χ=4.40, P=0.49, I=0%; ABO: χ=1.91, P=0.75, I=0%; PTB: χ=0.81, P=0.67, I=0%).
CONCLUSIONS
Exclusive breastfeeding, G6PD deficiency, ABO incompatibility and premature birth were confirmed as risk factors for neonatal hyperbilirubinemia. Pregnant women with risk factors should be monitored more closely and clinical intervention should be given in a timely manner.
PubMed: 35800274
DOI: 10.21037/tp-22-229 -
The need for neonatal jaundice screening awareness in the Pakistani population: short communication.Annals of Medicine and Surgery (2012) Aug 2023Neonatal jaundice is a common illness that affects around 80% of preterm and 50-60% of full-term newborn infants. It is one of the most common causes of neonatal death....
Neonatal jaundice is a common illness that affects around 80% of preterm and 50-60% of full-term newborn infants. It is one of the most common causes of neonatal death. Neonatal jaundice may be physiological or pathological. Physiologic jaundice is far more common than pathologic jaundice and accounts for most hyperbilirubinemia. Physiologic jaundice in neonates is due to greater hemoglobin breakdown compared to bilirubin clearance. While pathological jaundice occurs due to various infections, drug toxicity, inborn enzyme deficiencies, Rhesus fetal-maternal incompatibility, hypothyroidism, and congenital biliary duct obstruction diseases. In many parts of the world, midwives, and nurses perform spontaneous vaginal deliveries and they only rely on visual screening for neonatal jaundice. However, this is not reliable, especially for newborns having darker skin. Educating the mothers on screening for early detection of neonatal jaundice and seeking medical treatment in a country like Pakistan, which is considered a high-risk population, is crucial. Also, as most females give birth at home, hence, midwives' knowledge about neonatal jaundice also needs to be improved.
PubMed: 37554868
DOI: 10.1097/MS9.0000000000000960 -
Diagnostics (Basel, Switzerland) Apr 2021The molecular pathology of hemolytic disease of the fetus and newborn (HDFN) is determined by different , , and genotypes and by blood group incompatibility between the...
Risk Minimization of Hemolytic Disease of the Fetus and Newborn Using Droplet Digital PCR Method for Accurate Fetal Genotype Assessment of , , and from Cell-Free Fetal DNA of Maternal Plasma.
The molecular pathology of hemolytic disease of the fetus and newborn (HDFN) is determined by different , , and genotypes and by blood group incompatibility between the mother and fetus that is caused by erythrocyte antigen presence/absence on the cell surface. In the Czech Republic, clinically significant antierythrocyte alloantibodies include anti-D, anti-K, anti C/c, and anti-E. Deletion of the gene and then three single nucleotide polymorphisms in the and genes (rs676785, rs609320, and rs8176058) are the most common. The aim of this study is to develop effective and precise monitoring of fetal genotypes from maternal plasma of these polymorphisms using droplet digital (dd)PCR. Fifty-three plasma DNA samples (from 10 to 18 weeks of gestation) were analyzed (10 , 33 , and 10 ). The ddPCR methodology was validated on the basis of the already elaborated and established method of minisequencing and real-time PCR and with newborn phenotype confirmation. The results of ddPCR were in 100% agreement with minisequencing and real-time PCR and also with newborn phenotype. ddPCR can fully replace the reliable but more time-consuming method of minisequencing and real-time PCR examination. Accurate and rapid noninvasive fetal genotyping minimizes the possibility of HDFN developing.
PubMed: 33925253
DOI: 10.3390/diagnostics11050803 -
The Annals of Thoracic Surgery Nov 2022ABO-incompatible heart transplant is a method to increase the infant donor pool. However data on long-term survival and rejection after ABO-incompatible heart transplant...
BACKGROUND
ABO-incompatible heart transplant is a method to increase the infant donor pool. However data on long-term survival and rejection after ABO-incompatible heart transplant in recent era are limited.
METHODS
The United Network for Organ Sharing database was queried for infant heart transplants performed from January 2008 to March 2020. Patient demographics and known risk factors for posttransplant mortality were collected. Statistical analysis using Bayesian additive regression trees was performed to evaluate the association of ABO incompatibility and overall survival, graft survival, acute rejection episodes, and length of stay.
RESULTS
Of 1368 included infants (age < 1 year), 280 (20.47%) were ABO incompatible. ABO incompatibility was not associated with increased all-cause mortality, acute rejection episodes, or length of stay, whereas extracorporeal membrane oxygenation and intubation status of the recipient at the time of transplantation were associated with increased all-cause mortality and graft failure. Idiopathic cardiomyopathy was associated with a decreased likelihood of posttransplant all-cause mortality. One-, 5-, and 10-year survival rates among compatible vs incompatible transplants were estimated to be 90% vs 88%, 82% vs 79%, and 77% vs 73%, respectively.
CONCLUSIONS
ABO-incompatible infant heart transplant does not affect posttransplant survival, incidence of rejection, or postoperative length of stay. Therefore it remains a viable and important strategy to increase the infant donor pool.
Topics: Infant; Humans; United States; Blood Group Incompatibility; ABO Blood-Group System; Bayes Theorem; Heart Transplantation; Graft Survival; Graft Rejection
PubMed: 34582759
DOI: 10.1016/j.athoracsur.2021.08.039