Transplant Accommodation in Highly Sensitized Patients: A Potential Role for Bcl‐xL and Alloantibody

摘要: Transplantation of renal allografts into recipients with circulating anti-HLA antibodies results in hyperacute rejection. In some cases, however, return without causing harm; this phenomenon has been termed ‘accommodation’. We have investigated process human allotransplantation. We removed by immunoadsorption seven highly sensitized dialysis patients who subsequently underwent transplantation. Immunohistochemistry biopsies for IgG and anti-apoptotic proteins was performed. also developed a model ‘accommodation’ using eluted from incubated umbilical vein endothelial cells (HUVECs) at different concentrations. Their effect on HUVEC phenotype then analysed. Anti-donor antibody returned 4/7 patients, evidence Three out four these ‘accommodated’ grafts showed specific up-regulation Bcl-xL 2/2 tested positive deposition. HUVECs subsaturating concentrations increased expression Bcl-xL, were rendered refractory to cell activation became resistant complement-mediated lysis. contrast, saturating expressed low levels Bcl-xL. In conclusion, defines the accommodation may be initiated exposure endothelium anti-donor HLA antibodies.