Figure 1
November 1, 2007
As many of you have already noticed, the CTS website has received a "face lift" to an updated modern layout. In addition, small improvements have been made to make the site more user-friendly. You can now even go beyond your interest in science to have a look at "Heidelberg Impressions" under "Participants". We appreciate suggestions for further improvements. Please let us know if you have a good idea.
Most centers have returned the "Cancer Confirmation Questionnaire". If you have not done so, please send us the completed questionnaire at your earliest convenience. If it is not possible for you to obtain the cancer data, please check the appropriate box and return the questionnaire in order to avoid future reminders. Centers will be included in the cancer analysis only if the green confirmation questionnaire has been returned. Thank you for your cooperation.
May I remind you that the next deadline for shipping DNA and sera for the ongoing studies is on or about
November 19/20, 2007.
Please follow the usual procedure and inform us of shipment details by email, fax or phone.
If you have started to collect specimens only recently, you may choose to send your samples either in November or at the next shipping date, which will be May 19/20, 2008. Be sure to store all serum and DNA samples frozen!
It has been known for many years that blood transfusions are a significant cause of pretransplant lymphocytotoxic antibodies in transplant recipients. We would like to provide you with a summary of the CTS data on transfusions and antibodies.
Figure 1 shows the notable association between the number of pretransplant transfusions and the occurrence of anti-lymphocyte antibodies (0 %, 1-50 %, > 50 % panel reactive antibodies).
Figure 1
Interestingly, we found very little difference between adult and pediatric recipients. The results for children are illustrated in Figure 2.
Figure 2
Because pregnancies are known to have an important additional sensitizing influence, the results for female and male recipients are depicted separately in Figure 3. Clearly, higher rates of antibody production were observed in female recipients, in all likelihood a consequence of the immunostimulatory influence of pregnancies.
Figure 3
Not surprisingly, antibodies in retransplant recipients are higher than those in first transplant recipients (Figure 4). Rejection of a previous graft is a known potent inducer of anti-lymphocyte antibodies.
Figure 4
The most interesting result is illustrated in Figure 5. Whereas all previous grafts, depicting the frequency of lymphocytotoxic antibodies, showed a strong association between the number of blood transfusions and antibody development, we found no influence of blood transfusions on the development of antibodies against MICA. The figure presents in greater detail the results reported in the recent New England Journal of Medicine article (N Engl J Med 2007; 357: 1293-300). The difference between the results of anti-lymphocyte antibodies (presumably directed against HLA) and MICA antibodies is striking. For the time being, the mechanism through which MICA antibodies are induced remains unknown. Much work remains to be done to elucidate the reason for MICA antibodies, the usefulness of screening patient sera and performing MICA-specific crossmatches, and the possibility of matching for MICA antigens in the case of presensitization.
Figure 5
We are grateful to all those who contributed to the CTS Serum Study for their support of the advancement of knowledge in this field. The expansion of knowledge on the role of pre- and posttransplant antibodies against HLA, MICA, and other transplantation antigens provides an important opportunity to develop specific clinical strategies. If you are not currently taking part in this initiative, please consider joining the CTS Serum Study now!
With the first newsletter of the year we are planning to perform a complete update of the CTS website results. We would therefore appreciate it greatly if your follow-up documentation could arrive at our office not later than January 20, 2008. It is a formidable task for our computer staff to process all incoming data in time for the generation of the website results. We appreciate your cooperation!
Sincerely yours,