Scholars@Duke
Annette M Jackson

Annette M Jackson

Associate Professor in Surgery
Surgery, Abdominal Transplant Surgery
annette.m.jackson@duke.edu
Box 2645 Med Ctr, Durham, NC 27710
DUMC 2645, Durham, NC 27710

Selected Publications

Interrogating post-transplant donor HLA-specific antibody characteristics and effector functions using clinical bead assays.

Journal Article Hum Immunol · October 1, 2024 Single antigen bead (SAB) assays are the most common and sensitive method used to detect and monitor post-transplant donor specific HLA antibodies (DSA). However, a direct comparison across traditional and modified SAB assays to improve routine DSA monitor ... Full text Link to item Cite

Allosensitisation in NHP results in cross-reactive anti-SLA antibodies not detected by a lymphocyte-based flow cytometry crossmatch.

Journal Article HLA · July 2024 Xenotransplantation is a potential option for individuals for whom an acceptable human allograft is unavailable. Individuals with broadly reactive HLA antibodies due to prior exposure to foreign HLA are potential candidates for a clinical xenotransplant tr ... Full text Link to item Cite

Banff 2022 Liver Group Meeting report: Monitoring long-term allograft health.

Journal Article Am J Transplant · June 2024 The Banff Working Group on Liver Allograft Pathology met in September 2022. Participants included hepatologists, surgeons, pathologists, immunologists, and histocompatibility specialists. Presentations and discussions focused on the evaluation of long-term ... Full text Link to item Cite

The Banff 2022 Kidney Meeting Work Plan: Data-driven refinement of the Banff Classification for renal allografts.

Journal Article Am J Transplant · March 2024 The XVIth Banff Meeting for Allograft Pathology was held in Banff, Alberta, Canada, from September 19 to 23, 2022, as a joint meeting with the Canadian Society of Transplantation. In addition to a key focus on the impact of microvascular inflammation and b ... Full text Link to item Cite

Summary of a consensus conference on heart-liver transplantation.

Journal Article Am J Transplant · March 2024 Patients with severe heart disease may have coexisting liver disease from various causes. The incidence of combined heart-liver transplant (CHLT) is increasing as more patients with congenital heart disease survive to adulthood and develop advanced heart f ... Full text Link to item Cite

The impact of IdeS (imlifidase) on allo-specific, xeno-reactive, and protective antibodies in a sensitized rhesus macaque model.

Journal Article Xenotransplantation · 2024 BACKGROUND: Highly sensitized patients face many barriers to kidney transplantation, including higher rates of antibody-mediated rejection after HLA-incompatible transplant. IdeS, an endopeptidase that cleaves IgG nonspecifically, has been trialed as desen ... Full text Link to item Cite

Is Allosensitization Detrimental to Pig Organ Xenotransplantation, and Is Xenosensitization Detrimental to Subsequent Organ Allotransplantation? A Debate Organized by the International Xenotransplantation Association (IXA).

Journal Article Xenotransplantation · 2024 This report summarizes the content of a debate sponsored by eGenesis Bio, organized by the International Xenotransplantation Association (IXA), and attended by more than 150 delegates in the context of the IPITA-IXA-CTRMS Joint Congress held in San Diego i ... Full text Link to item Cite

Selection and Interpretation of Molecular Diagnostics in Heart Transplantation.

Journal Article Circulation · August 22, 2023 The number of heart transplants performed annually in the United States and worldwide continues to increase, but there has been little change in graft longevity and patient survival over the past 2 decades. The reference standard for diagnosis of acute cel ... Full text Link to item Cite

Understanding heterogeneity of human bone marrow plasma cell maturation and survival pathways by single-cell analyses.

Journal Article Cell Rep · July 25, 2023 Human bone marrow (BM) plasma cells are heterogeneous, ranging from newly arrived antibody-secreting cells (ASCs) to long-lived plasma cells (LLPCs). We provide single-cell transcriptional resolution of 17,347 BM ASCs from five healthy adults. Fifteen clus ... Full text Link to item Cite

Multicenter Validation of a Urine CXCL10 Assay for Noninvasive Monitoring of Renal Transplants.

Journal Article Transplantation · July 1, 2023 BACKGROUND: Urine CXCL10 (C-X-C motif chemokine ligand 10, interferon gamma-induced protein 10 [IP10]) outperforms standard-of-care monitoring for detecting subclinical and early clinical T-cell-mediated rejection (TCMR) and may advance TCMR therapy develo ... Full text Link to item Cite

The evolving use of biomarkers in heart transplantation: Consensus of an expert panel.

Journal Article Am J Transplant · June 2023 In heart transplantation, the use of biomarkers to detect the risk of rejection has been evolving. In this setting, it is becoming less clear as to what is the most reliable test or combination of tests to detect rejection and assess the state of the alloi ... Full text Link to item Cite

Risk factors associated with Hepatitis E virus infection in kidney transplant recipients in a single tertiary Center in the United States.

Journal Article Transpl Immunol · June 2023 BACKGROUND: Hepatitis E virus (HEV), the causative agent of hepatitis E, is a common but self-limiting disease. However, in immunosuppressed kidney transplant 47 recipients (KTRs), HEV infection can become chronic. We investigated risk factors associated w ... Full text Link to item Cite

Desensitization and belatacept-based maintenance therapy in pregnancy-sensitized monkeys receiving a kidney transplant.

Journal Article Sci Adv · May 19, 2023 Among sensitized patients awaiting a transplant, females are disproportionately represented, partly because of pregnancy-induced sensitization. Using female NHPs sensitized by pregnancy alone, we examined the efficacy of costimulation blockade and proteaso ... Full text Link to item Cite

Addressing sex-based disparities in solid organ transplantation in the United States - a conference report.

Journal Article Am J Transplant · March 2023 Solid organ transplantation provides the best treatment for end-stage organ failure, but significant sex-based disparities in transplant access exist. On June 25, 2021, a virtual multidisciplinary conference was convened to address sex-based disparities in ... Full text Link to item Cite

Diagnostic Potential of Minimally Invasive Biomarkers: A Biopsy-centered Viewpoint From the Banff Minimally Invasive Diagnostics Working Group.

Journal Article Transplantation · January 2023 With recent advances and commercial implementation of minimally invasive biomarkers in kidney transplantation, new strategies for the surveillance of allograft health are emerging. Blood and urine-based biomarkers can be used to detect the presence of reje ... Full text Cite

Transcriptional responses define dysregulated immune activation in Hepatitis C (HCV)-naïve recipients of HCV-infected donor kidneys.

Journal Article PLoS One · 2023 Renal transplantation from hepatitis C (HCV) nucleic acid amplification test-positive (NAAT-positive) donors to uninfected recipients has greatly increased the organ donation pool. However, there is concern for adverse outcomes in these recipients due to d ... Full text Link to item Cite

Sensitization in transplantation: Assessment of Risk 2022 Working Group Meeting Report.

Conference Am J Transplant · January 2023 The Sensitization in Transplantation: Assessment of Risk workgroup is a collaborative effort of the American Society of Transplantation and the American Society of Histocompatibility and Immunogenetics that aims at providing recommendations for clinical te ... Full text Link to item Cite

Genetic risk variants for childhood nephrotic syndrome and corticosteroid response.

Journal Article Front Pediatr · 2023 INTRODUCTION: The etiology of most cases of nephrotic syndrome (NS) remains unknown, therefore patients are phenotypically categorized based on response to corticosteroid therapy as steroid sensitive NS (SSNS), or steroid resistant NS (SRNS). Genetic risk ... Full text Link to item Cite

The Histocompatibility Lab: Alloantibodies, Sensitization, and the Virtual Crossmatch

Chapter · January 1, 2023 One of the most complex and difficult decisions for a heart failure (HF) team to wrestle with is the timing of placing a left ventricular assist device (LVAD) versus waiting for a donor heart to be available. This chapter provides a guide to providers that ... Full text Cite

Translation of therapeutic strategies to modulate B cell reponses from non-human primate models to human kidney transplantation.

Journal Article Front Transplant · 2023 Using novel drugs targeting lymphocyte costimulation, cytokines, antibody, complement, and plasma cells, we have developed strategies in a non-human primate model to modulate the B cell response to incompatible kidney transplants. After more than two decad ... Full text Link to item Cite

Hepatitis E virus infection and rejection in kidney transplant recipients.

Journal Article Transpl Immunol · February 2022 BACKGROUND: Hepatitis E virus (HEV) infection has been associated with immune-mediated kidney diseases in developing countries. However, its relationship with kidney transplant outcomes has never been studied. We investigated the association between HEV in ... Full text Link to item Cite

Harnessing the B Cell Response in Kidney Transplantation - Current State and Future Directions.

Journal Article Front Immunol · 2022 Despite dramatic improvement in kidney transplantation outcomes over the last decades due to advent of modern immunosuppressive agents, long-term outcomes remain poor. Antibody-mediated rejection (ABMR), a B cell driven process, accounts for the majority o ... Full text Link to item Cite

A cell-based multiplex immunoassay platform using fluorescent protein-barcoded reporter cell lines.

Journal Article Commun Biol · November 25, 2021 Multiplex immunoassays with acellular antigens are well-established based on solid-phase platforms such as the Luminex® technology. Cell barcoding by amine-reactive fluorescent dyes enables analogous cell-based multiplex assays, but requires multiple label ... Full text Open Access Link to item Cite

Cell-free DNA diagnostics in transplantation utilizing next generation sequencing.

Journal Article Hum Immunol · November 2021 The use of Next Generation Sequencing (NGS) to interrogate cell-free DNA (cfDNA) as a transplant diagnostic provides a crucial step in improving the accuracy of post-transplant monitoring of allograft health. cfDNA interrogation provides a powerful, yet mi ... Full text Link to item Cite

HLA Loci and Recurrence of Focal Segmental Glomerulosclerosis in Pediatric Kidney Transplantation.

Journal Article Transplant Direct · October 2021 UNLABELLED: Recurrent focal segmental glomerulosclerosis (FSGS) after kidney transplantation accounts for the majority of allograft failures in children with primary FSGS. Although current research focuses on FSGS pathophysiology, a common etiology and mec ... Full text Open Access Link to item Cite

Efficacy and Safety of Immunosuppression Withdrawal in Pediatric Liver Transplant Recipients: Moving Toward Personalized Management.

Journal Article Hepatology · May 2021 BACKGROUND AND AIMS: Tolerance is transplantation's holy grail, as it denotes allograft health without immunosuppression and its toxicities. Our aim was to determine, among stable long-term pediatric liver transplant recipients, the efficacy and safety of ... Full text Link to item Cite

A 2020 Banff Antibody-mediatedInjury Working Group examination of international practices for diagnosing antibody-mediated rejection in kidney transplantation - a cohort study.

Journal Article Transpl Int · March 2021 The Banff antibody-mediated rejection (ABMR) classification is vulnerable to misinterpretation, but the reasons are unclear. To better understand this vulnerability, we evaluated how ABMR is diagnosed in practice. To do this, the Banff Antibody-Mediated In ... Full text Link to item Cite

Emerging New Approaches in Desensitization: Targeted Therapies for HLA Sensitization.

Journal Article Front Immunol · 2021 There is an urgent need for therapeutic interventions for desensitization and antibody-mediated rejection (AMR) in sensitized patients with preformed or de novo donor-specific HLA antibodies (DSA). The risk of AMR and allograft loss in sensitized patients ... Full text Link to item Cite

Allo-Specific Humoral Responses: New Methods for Screening Donor-Specific Antibody and Characterization of HLA-Specific Memory B Cells.

Journal Article Front Immunol · 2021 Antibody-mediated allograft rejection (AMR) causes more kidney transplant failure than any other single cause. AMR is mediated by antibodies recognizing antigens expressed by the graft, and antibodies generated against major histocompatibility complex (MHC ... Full text Open Access Link to item Cite

Editorial: Sensitization and Desensitization in Organ Transplantation.

Journal Article Frontiers in immunology · January 2021 Full text Cite

The role of non-HLA antibodies in solid organ transplantation: a complex deliberation.

Journal Article Curr Opin Organ Transplant · December 2020 PURPOSE OF REVIEW: There is tremendous interest in understanding when, if, and how non-HLA antibodies contribute to allograft injury. Numerous non-HLA target antigens have been identified and sensitization to these targets have been associated with delayed ... Full text Link to item Cite

Tailored use of belatacept in adolescent kidney transplantation.

Journal Article Am J Transplant · March 2020 Adolescent transplant recipients are at risk for nonadherence, development of de novo donor-specific antibody (dnDSA), and allograft loss. Belatacept, a selective T cell costimulatory blocker, is associated with reduced dnDSA, improved renal function, and ... Full text Link to item Cite

The impact of belatacept on third-party HLA alloantibodies in highly sensitized kidney transplant recipients.

Journal Article Am J Transplant · February 2020 Recent evidence suggests that belatacept reduces the durability of preexisting antibodies to class I and class II human leukocyte antigens (HLAs). In this case series of 163 highly sensitized kidney transplant candidates whose calculated panel-reactive ant ... Full text Link to item Cite

IgG4 donor-specific HLA antibody profile is associated with subclinical rejection in stable pediatric liver recipients.

Journal Article Am J Transplant · February 2020 The impact of donor-specific HLA antibody (DSA) following liver transplantation remains controversial. We hypothesized DSA IgG subclass characteristics, compared to total DSA IgG, might correlate with specific histopathological phenotype(s) of subclinical ... Full text Link to item Cite

B cells in transplant tolerance and rejection: friends or foes?

Journal Article Transpl Int · January 2020 Our understanding of the role of B cells in organ transplantation remains incomplete and continues to grow. The majority of research has focused on the detrimental role of antibodies that drive the development of pathogenesis of the transplanted organ. How ... Full text Link to item Cite

Waiting List and Transplant Outcomes of Highly Sensitized Kidney Patients

Conference AMERICAN JOURNAL OF TRANSPLANTATION · 2020 Cite

Prediction system for risk of allograft loss in patients receiving kidney transplants: international derivation and validation study.

Journal Article BMJ · September 17, 2019 OBJECTIVE: To develop and validate an integrative system to predict long term kidney allograft failure. DESIGN: International cohort study. SETTING: Three cohorts including kidney transplant recipients from 10 academic medical centres from Europe and the U ... Full text Link to item Cite

Sensitization to endothelial cell antigens: Unraveling the cause or effect paradox.

Journal Article Hum Immunol · August 2019 Anti-endothelial cell antibodies (AECAs) have been correlated with increased acute and chronic rejection across all organ types and early graft dysfunction in kidney and heart transplantation. Nevertheless, the lack of appropriate tools and clear criteria ... Full text Link to item Cite

Temporal Changes in the Impact of HLA Mismatching Among Pediatric Kidney Transplant Recipients.

Journal Article Transplantation · June 2019 BACKGROUND: Allocation for pediatric deceased-donor kidney transplantation (pDDKT) in the United States now de-emphasizes HLA matching to improve equality in access to transplantation, but other national systems still consider HLA matching due to concerns ... Full text Link to item Cite

Microvascular inflammation in renal allograft biopsies assessed by endothelial and leukocyte co-immunostain: a retrospective study on reproducibility and clinical/prognostic correlates.

Journal Article Transpl Int · March 2019 The most prominent histologic lesion in antibody-mediated rejection is microvascular inflammation (MVI); however, its recognition and scoring can be challenging and poorly reproducible between pathologists. We developed a dual immunohistochemical (IHC)-sta ... Full text Link to item Cite

Early Risks of Death, Stroke/Systemic Embolism, and Major Bleeding in Patients With Newly Diagnosed Atrial Fibrillation.

Journal Article Circulation · February 5, 2019 BACKGROUND: Atrial fibrillation is associated with increased risks of death, stroke/systemic embolism, and bleeding (incurred by antithrombotic therapy), which may occur early after diagnosis. METHODS: We assessed the risk of early events (death, stroke/sy ... Full text Link to item Cite

Risk Profile and 1-Year Outcome of Newly Diagnosed Atrial Fibrillation in Japan　- Insights From GARFIELD-AF.

Journal Article Circ J · December 25, 2018 BACKGROUND: Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective non-interventional study of stroke prevention in patients with newly diagnosed non-valvular AF (NAVF) that is being conducted in 35 countries ... Full text Link to item Cite

Minimal data reporting standards for serological testing for histocompatibility.

Journal Article Hum Immunol · December 2018 Histocompatibility testing, and HLA antibody screening in particular, varies in practice among laboratories. Currently, standards are lacking regarding the reporting of testing methods in publications. It is essential that scientific methods are rigorously ... Full text Link to item Cite

Evidence of Chronic Allograft Injury in Liver Biopsies From Long-term Pediatric Recipients of Liver Transplants.

Journal Article Gastroenterology · December 2018 BACKGROUND & AIMS: A substantial proportion of pediatric liver transplant recipients develop subclinical chronic allograft injury. We studied whether there are distinct patterns of injury based on histopathologic features and identified associated immunolo ... Full text Link to item Cite

Meeting report of the STAR-Sensitization in Transplantation Assessment of Risk: Naïve Abdominal Transplant Organ subgroup focus on kidney transplantation.

Journal Article Am J Transplant · September 2018 The development of de novo donor-specific HLA antibody (dnDSA) is a critical feature contributing to late allograft failure. The complexity of the issue is further complicated by organ-specific differences, detection techniques, reliance of tissue histopat ... Full text Link to item Cite

Sensitization in Transplantation: Assessment of Risk (STAR) 2017 Working Group Meeting Report.

Journal Article Am J Transplant · July 2018 The presence of preexisting (memory) or de novo donor-specific HLA antibodies (DSAs) is a known barrier to successful long-term organ transplantation. Yet, despite the fact that laboratory tools and our understanding of histocompatibility have advanced sig ... Full text Link to item Cite

Late manifestation of alloantibody-associated injury and clinical pulmonary antibody-mediated rejection: Evidence from cell-free DNA analysis.

Journal Article J Heart Lung Transplant · July 2018 BACKGROUND: Antibody-mediated rejection (AMR) often progresses to poor health outcomes in lung transplant recipients (LTRs). This, combined with the relatively insensitive clinical tools used for its diagnosis (spirometry, histopathology) led us to determi ... Full text Link to item Cite

Complement-activating donor-specific anti-HLA antibodies and solid organ transplant survival: A systematic review and meta-analysis.

Journal Article PLoS Med · May 2018 BACKGROUND: Anti-human leukocyte antigen donor-specific antibodies (anti-HLA DSAs) are recognized as a major barrier to patients' access to organ transplantation and the major cause of graft failure. The capacity of circulating anti-HLA DSAs to activate co ... Full text Link to item Cite

Pre-transplant Screening for Non-HLA Antibodies: Who should be Tested?

Journal Article Hum Immunol · April 2018 Retrospective studies of angiotensin II type 1 receptor antibodies (AT1R-Ab) and anti-endothelial cell antibodies (AECA) have linked these antibodies to allograft injury. Because rising healthcare costs dictate judicious use of laboratory testing, we sough ... Full text Link to item Cite

Corrigendum: Novel non-histocompatibility antigen mismatched variants improve the ability to predict antibody-mediated rejection risk in kidney transplant [Front Immunol, 8, (2017) (1687)] DOI: 10.3389/fimmu.2017.01687

Journal Article Frontiers in Immunology · January 31, 2018 Text Correction. In the original article, there was an error. The data were intended to be shared in dbGap, but because of some issues in the inform consent, the data cannot be uploaded to dbGap, so we are modifying the way the data will be shared. A corre ... Full text Cite

Novel non-histocompatibility antigen mismatched variants improve the ability to predict antibody-mediated rejection risk in kidney transplant

Journal Article Frontiers in Immunology · December 5, 2017 Transplant rejection is the critical clinical end-point limiting indefinite survival after histocompatibility antigen (HLA) mismatched organ transplantation. The predominant cause of late graft loss is antibody-mediated rejection (AMR), a process whereby i ... Full text Cite

Nontraditional sites for vascular anastomoses to enable kidney transplantation in patients with major systemic venous thromboses.

Journal Article Clin Transplant · December 2017 Successful renal transplantation requires low-pressure venous drainage to permit adequate outflow from the allograft. We report here a series of three patients in whom the inferior vena cava as well as bilateral iliac veins were thrombosed, making it neces ... Full text Link to item Cite

Applying rigor and reproducibility standards to assay donor-derived cell-free DNA as a non-invasive method for detection of acute rejection and graft injury after heart transplantation.

Journal Article J Heart Lung Transplant · September 2017 BACKGROUND: Use of new genomic techniques in clinical settings requires that such methods are rigorous and reproducible. Previous studies have shown that quantitation of donor-derived cell-free DNA (%ddcfDNA) by unbiased shotgun sequencing is a sensitive, ... Full text Link to item Cite

Histopathologic changes in anti-angiotensin II type 1 receptor antibody-positive kidney transplant recipients with acute rejection and no donor specific HLA antibodies.

Journal Article Hum Immunol · April 2017 OBJECTIVE: To determine the association of antibodies against angiotensin II type 1 receptor (AT1R Ab) and histopathologic changes seen in patients with kidney allograft rejection and negative donor specific HLA antibodies (DSA). METHODS: Stored sera from ... Full text Link to item Cite

Anti-Angiotensin II Type 1 Receptor and Anti-Endothelial Cell Antibodies: A Cross-Sectional Analysis of Pathological Findings in Allograft Biopsies.

Journal Article Transplantation · March 2017 BACKGROUND: This is a cross-sectional study designed to evaluate the histologic characteristics of graft injury in the presence of anti-angiotensin II type 1 receptor antibody (AT1R-Ab) and anti-endothelial cell antibody (AECA). METHODS: Non-HLA antibody t ... Full text Link to item Cite

Casting a smaller net into a bigger donor pool: A single center's experience with the new kidney allocation system.

Journal Article Hum Immunol · January 2017 The new kidney allocation system (KAS) provides additional allocation points for candidates with broad HLA sensitization in an effort to increase transplant rates for this underserved population. Following the implementation of KAS, our center lowered the ... Full text Link to item Cite

Plasma-Derived C1 Esterase Inhibitor for Acute Antibody-Mediated Rejection Following Kidney Transplantation: Results of a Randomized Double-Blind Placebo-Controlled Pilot Study.

Journal Article Am J Transplant · December 2016 Antibody-mediated rejection (AMR) is typically treated with plasmapheresis (PP) and intravenous immunoglobulin (standard of care; SOC); however, there is an unmet need for more effective therapy. We report a phase 2b, multicenter double-blind randomized pl ... Full text Link to item Cite

Splenic Irradiation for the Treatment of Severe Antibody-Mediated Rejection.

Journal Article Am J Transplant · October 2016 Patients requiring desensitization prior to renal transplantation are at risk for developing severe antibody-mediated rejection (AMR) refractory to treatment with plasmapheresis and intravenous immunoglobulin (PP/IVIg). We have previously reported success ... Full text Link to item Cite

Non-HLA antibodies in transplantation: when do they matter?

Journal Article Curr Opin Organ Transplant · August 2016 PURPOSE OF REVIEW: A growing interest in the contribution of non-human leukocyte antigens (non-HLA) antibodies to allograft rejection has led to the identification of multiple target antigens and investigation into the possible mechanisms of injury. Althou ... Full text Link to item Cite

Hepatitis E virus infection among solid organ transplant recipients at a North American transplant center

Journal Article Open Forum Infectious Diseases · January 1, 2016 Background. Autochthonous hepatitis E virus (HEV) infection has been reported in over 200 solid organ transplant (SOT) recipients since 2006, yet little is known about the burden of HEV among SOT recipients in North America. We performed a retrospective, c ... Full text Cite

Variable HLA expression on deceased donor lymphocytes: Not all crossmatches are created equal.

Journal Article Hum Immunol · November 2015 Flow cytometric crossmatch tests are used to detect donor-specific antibody and determine eligibility for transplantation. Crossmatch sensitivity is dependent on lymphocyte quality, to include HLA expression on the cell surface. The impact of HLA expressio ... Full text Link to item Cite

Endothelial cell antibodies associated with novel targets and increased rejection.

Journal Article J Am Soc Nephrol · May 2015 The initial contact point between a recipient's immune system and a transplanted graft is the vascular endothelium. Clinical studies suggest a pathogenic role for non-HLA antiendothelial cell antibodies (AECAs) in allograft rejection; however, evidence lin ... Full text Link to item Cite

A closer look at rituximab induction on HLA antibody rebound following HLA-incompatible kidney transplantation.

Journal Article Kidney Int · February 2015 Rituximab has been used to increase the efficacy of desensitization protocols for human leukocyte antigen (HLA)-incompatible kidney transplantation; however, controlled comparisons have not been reported. Here we examined 256 post-transplant HLA antibody l ... Full text Link to item Cite

Quantifying renal allograft loss following early antibody-mediated rejection.

Journal Article Am J Transplant · February 2015 Unlike antibody-mediated rejection (AMR) with clinical features, it remains unclear whether subclinical AMR should be treated, as its effect on allograft loss is unknown. It is also uncertain if AMR's effect is homogeneous across donor (deceased/live) and ... Full text Link to item Cite

A circulating antibody panel for pretransplant prediction of FSGS recurrence after kidney transplantation.

Journal Article Sci Transl Med · October 1, 2014 Recurrence of focal segmental glomerulosclerosis (rFSGS) after kidney transplantation is a cause of accelerated graft loss. To evaluate pathogenic antibodies (Abs) in rFSGS, we processed 141 serum samples from 64 patients with and without primary rFSGS and ... Full text Link to item Cite

Sensitized Patients, Transplant, and Management

Journal Article Current Transplantation Reports · June 1, 2014 Sensitization to human leukocyte antigens (HLA) creates significant barriers for renal transplant candidates, reducing access to transplantation by limiting donor availability and increasing the risk of rejection. Sensitized patients also endure longer wai ... Full text Cite

The Virtual Crossmatch: An Essential Tool for Transplanting Sensitized Patients.

Journal Article Clin Transpl · 2014 Improved virtual crossmatch assessments following the implementation of solid phase HLA antibody immunoassays has significantly impacted transplantation of sensitized candidates, using either deceased or living donor organs. In deceased donor transplants, ... Link to item Cite

Transplanting the highly sensitized patient: trials and tribulations.

Journal Article Curr Opin Nephrol Hypertens · November 2013 PURPOSE OF REVIEW: Humoral sensitization to antigens of the human leukocyte antigen and ABO systems remains one of the largest barriers to further expansion in renal transplantation. This barrier translates into prolonged waiting time and a greater likelih ... Full text Link to item Cite

Podocyte effacement closely links to suPAR levels at time of posttransplantation focal segmental glomerulosclerosis occurrence and improves with therapy.

Journal Article Transplantation · October 15, 2013 BACKGROUND: Focal segmental glomerulosclerosis (FSGS) recurs after kidney transplantation in more than 30% of cases and can lead to allograft loss. Serum soluble urokinase-type plasminogen activator receptor (suPAR) is implicated in the pathogenesis of nat ... Full text Link to item Cite

A flow cytometric crossmatch test using endothelial precursor cells isolated from peripheral blood.

Journal Article Methods Mol Biol · 2013 Flow cytometric crossmatch tests provide a donor-specific, cell based method for the detection of alloreactive antibodies in the sera of transplant patients. Conventional crossmatch tests used in solid organ transplantation utilize lymphocytes as target ce ... Full text Link to item Cite

A GPS for finding the route to transplantation for the sensitized patient.

Journal Article Curr Opin Organ Transplant · August 2012 PURPOSE OF REVIEW: To identify factors that affect the choice of route to renal transplantation for the sensitized patient. The evolution of protocols for transplanting sensitized patients has been desensitization (DES), paired donation, and most recently, ... Full text Link to item Cite

Multiple hyperacute rejections in the absence of detectable complement activation in a patient with endothelial cell reactive antibody.

Journal Article Am J Transplant · June 2012 This case involves a 54-year-old patient with polycystic kidney disease and a history of hyperacute allograft rejections. Two previous compatible live donor transplants functioned immediately but failed within the first 12 h due to antibody-injury. This pa ... Full text Link to item Cite

Using donor exchange paradigms with desensitization to enhance transplant rates among highly sensitized patients.

Journal Article Curr Opin Organ Transplant · August 2011 PURPOSE OF REVIEW: Many sensitized patients have willing live donors but are unable to use them because of a human leukocyte antigen (HLA) incompatibility. The options for these patients include: remaining on the deceased-donor list, entering a kidney-pair ... Full text Link to item Cite

Clinical relevance and IgG subclass determination of non-HLA antibodies identified using endothelial cell precursors isolated from donor blood.

Journal Article Transplantation · July 15, 2011 BACKGROUND: ABO and human leukocyte antigen (HLA) alloantibodies provide major immunologic barriers to successful transplantation; however, there is increasing recognition for the role of anti-endothelial cell antibodies (AECAs) in allograft rejection. We ... Full text Link to item Cite

Impact of pronase on flow cytometric crossmatch outcome.

Journal Article Hum Immunol · April 2011 Pronase treatment of lymphocytes is used to reduce nonspecific binding of immunoglobulins in flow cytometric crossmatch (FCXM) tests and at higher concentrations to remove CD20 from the cell surface. We examined the effect of pronase treatment on human leu ... Full text Link to item Cite

Immunogenetics and immunology in transplantation.

Journal Article Immunol Res · July 2010 Advances in immunogenetics and histocompatibility have facilitated the clinical transplantation of solid organs and tissues. Improved definition of HLA antigens, alleles, and haplotypes has clarified the diversity of the HLA system among different racial/e ... Full text Link to item Cite

Multicenter evaluation of a novel endothelial cell crossmatch test in kidney transplantation.

Journal Article Transplantation · February 27, 2009 BACKGROUND: Despite their clinical importance, clinical routine tests to detect anti-endothelial cell antibodies (AECA) in organ transplantation have not been readily available. This multicenter prospective kidney transplantation trial evaluates the effica ... Full text Link to item Cite

The problem of transplanting the sensitized patient: whose problem is it?

Journal Article Front Biosci · January 1, 2008 Transplantation is the treatment of choice for end-stage renal failure and a life-saving treatment for failure of other major organs. Improvements in surgical techniques, histocompatibility testing, and immunosuppressive drugs have significantly improved b ... Full text Link to item Cite

A role for MAPK in feedback inhibition of Tcrb recombination.

Journal Article J Immunol · June 1, 2006 The Tcrb locus is subject to a host of regulatory mechanisms that impart a strict cell and developmental stage-specific order to variable (V), diversity (D), and joining (J) gene segment recombination. The Tcrb locus is also regulated by allelic exclusion ... Full text Link to item Cite

Turning T-cell receptor beta recombination on and off: more questions than answers.

Journal Article Immunol Rev · February 2006 Successful V(D)J recombination at the T-cell receptor beta (Tcrb) locus is critical for early thymocyte development. The locus is subject to a host of regulatory mechanisms that impart a strict developmental order to Tcrb recombination events and that insu ... Full text Link to item Cite

Allele-specific regulation of TCR beta variable gene segment chromatin structure.

Journal Article J Immunol · October 15, 2005 Allelic exclusion of the murine Tcrb locus is imposed at the level of recombination and restricts each cell to produce one functional VDJbeta rearrangement. Allelic exclusion is achieved through asynchronous Vbeta to DJbeta recombination as well as feedbac ... Full text Link to item Cite

Regulation of T cell receptor beta allelic exclusion at a level beyond accessibility.

Journal Article Nat Immunol · February 2005 Allelic exclusion of V(beta)-to-DJ(beta) recombination depends on asynchronous rearrangement of alleles of the gene encoding T cell receptor beta in double-negative thymocytes and feedback inhibition that is maintained in double-positive thymocytes. Feedba ... Full text Link to item Cite

Regulation of E2A gene expression in B-lymphocyte development.

Journal Article Mol Immunol · March 2004 Biochemical and genetic studies have demonstrated that transcription factors encoded by the E2A gene are essential in regulating B lineage specific gene expression and B lineage commitment. However, the mechanism by which E2A regulates B lineage commitment ... Full text Link to item Cite

A change in the structure of Vbeta chromatin associated with TCR beta allelic exclusion.

Journal Article J Immunol · March 1, 2002 To investigate chromatin control of TCR beta rearrangement and allelic exclusion, we analyzed TCR beta chromatin structure in double negative (DN) thymocytes, which are permissive for TCR beta recombination, and in double positive (DP) thymocytes, which ar ... Full text Link to item Cite

Peripheral blood allogeneic microchimerism in lung and cardiac allograft recipients.

Conference J Leukoc Biol · August 1999 We have been investigating two parameters, donor antigen-specific hyporeactivity and peripheral blood allogeneic microchimerism, to determine whether these parameters will predict a chronic rejection-free state and which recipients may be candidates for st ... Full text Link to item Cite

Pretransplant exposure to donor HLA-DR antigen in random transfusion units and the development of donor antigen-specific hyporeactivity.

Journal Article Hum Immunol · July 1997 Our previous studies have shown that the in vitro assay of donor antigen-specific hyporeactivity is a useful marker for identifying solid organ transplant recipients (kidney, lung and heart) at low risk for immunologic complications (i.e., late acute rejec ... Full text Link to item Cite

Sequential measurement of peripheral blood allogeneic microchimerism levels and association with pulmonary function.

Conference Transplantation · December 27, 1996 We have shown in lung recipients that high levels of peripheral blood allogeneic microchimerism at 12 to 18 months posttransplant correlated with donor antigen-specific hyporeactivity (i.e., decreased proliferative response to donor antigen in MLC while re ... Full text Link to item Cite

Organ-specific patterns of donor antigen-specific hyporeactivity and peripheral blood allogeneic microchimerism in lung, kidney, and liver transplant recipients.

Journal Article Transplantation · December 27, 1995 Although their relative importance and interaction are unclear, donor antigen(Ag)*-specific hyporeactivity and allogeneic microchimerism have been associated with improved long-term graft outcome and a lower incidence of chronic rejection in solid organ tr ... Full text Link to item Cite

Allogeneic microchimerism and donor antigen-specific hyporeactivity in lung transplant recipients.

Journal Article Clin Transplant · December 1995 The identification of peripheral donor cells in solid organ transplant recipients has led to speculation as to the tolerogenic role of circulating donor cells. Also being debated is the possible significance of persistent donor alloantigen-presenting cells ... Link to item Cite