Wednesday, May 4, 2016

Interpreting Anti-HLA Antibody Testing Data: A Practical Guide for Physicians.

Transplantation - Published Ahead-of-Print Interpreting Anti-HLA Antibody Testing Data: A Practical Guide for Physicians.

The development of sensitive methods for alloantibody detection has been a significant advance in clinical transplantation. However, the complexity of the data from solid phase and crossmatch assays has led to potential confusion about how to use the results for clinical decision making. The goal of this review is to provide a practical guide for transplant physicians for the interpretation of antibody data to supplement consultation with local tissue typing experts. Sources of variability in both the solid phase and crossmatch assay are discussed as are recent data regarding C1q binding antibodies and IgG subclass testing. Although definitive approaches to alloantibody testing are not possible with our current knowledge, we outline a pragmatic approach that we hope will enhance clinical management in this area. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.


http://pdfs.journals.lww.com/transplantjournal/9000/00000/Interpreting_Anti_HLA_Antibody_Testing_Data___A.97437.pdf

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Alberto Reino Buelvas

Should asymptomatic bacteriuria be systematically treated in kidney transplant recipients? Results from a randomized controlled trial

AJT - Early Should asymptomatic bacteriuria be systematically treated in kidney transplant recipients? Results from a randomized controlled trial

Abstract

The indication of antimicrobial treatment for asymptomatic bacteriuria (AB) after kidney transplantation (KT) remains controversial. Between January 2011 and December 2013 112 KT recipients that developed ≥1 episode of AB beyond the second month post-transplantation were included in this open-label trial. Participants were randomized (1:1 ratio) to the treatment group (systematic antimicrobial therapy for all episodes of AB occurring up to 24 months post-transplantation [53 patients]) or control group (no antimicrobial therapy [59 patients]). Systematic screening for AB was similarly performed in both groups. The primary outcome was the occurrence of acute pyelonephritis at 24-month follow-up. Secondary outcomes included lower urinary tract infection, acute rejection, Clostridium difficile infection, colonization/infection by multidrug-resistant bacteria, graft function, and all-cause mortality. There were no differences in the primary outcome in the intention-to-treat (7.5% [4/53] in treatment group versus 8.4% [5/59] in control group; odds ratio [OR]: 0.88; 95% confidence interval [CI]: 0.22-3.47) or per-protocol populations (3.8% [1/26] in treatment group versus 8.0% [4/50] in control group; OR: 0.46; 95% CI: 0.05-4.34). We found no differences in any of the secondary outcomes either. In conclusion, systematic screening and treatment of AB beyond the second month after transplantation provide no apparent benefit among KT recipients (NCT02373085).

This article is protected by copyright. All rights reserved.




http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajt.13829

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Alberto Reino Buelvas