Baseline Titers Research Articles

ABO Incompatible Renal Transplantation Without Antibody Removal Using Conventional Immunosuppression Alone

ABO incompatible living donor renal transplantation (ABOi) can achieve outcomes comparable to ABO compatible transplantation (ABOc). However, with the exception of blood group A2 kidneys transplanted into recipients with low titer anti-A antibody, regimens generally include antibody removal, intensified immunosuppression and splenectomy or rituximab. We now report a series of 20 successful renal transplants across a range of blood group incompatibilities using conventional immunosuppression alone in recipients with low baseline anti-blood group antibody (ABGAb) titers. Incompatibilities were A1 to O (3), A1 to B (2), A2 to O (2), AB to A (2), AB to B (1), B to A1 (9), B to O (1); titers 1:1 to 1:16 by Ortho. At 36 months, patient and graft survival are 100%. Antibody-mediated rejection (AbMR) occurred in one patient with thrombophilia and low level donor-specific anti-HLA antibody. Four patients experienced cellular rejection (two subclinical), which responded to oral prednisolone. This series demonstrates that selected patients with low titer ABGAb can undergo ABOi with standard immunosuppression alone, suggesting baseline titer as a reliable predictor of AbMR. This reduces morbidity and cost of ABOi for patients with low titer ABGAb and increases the possibility of ABOi from deceased donors.

Abstract 11087: Autoantibody Titer Directed Against β1-Adrenergic Receptors is a Predictor of Reverse Remodeling During Carvedilol Therapy for Chronic Heart Failure: Japanese Chronic Heart Failure (J-CHF) Study

Introduction: Autoimmune disorder is one of the features characterizing congestive heart failure (CHF) not only due to idiopathic dilated cardiomyopathy, but due to other etiologies. Autoantibody directed against β1-adrenergic receptors (β1-AAb) exerts agonist-like action inducing receptor uncoupling, and elicits persistent myocardial damage. We, therefore, attempted to determine the significance of β1-AAb in patients with CHF who received β-blocker carvedilol in the substudy of J-CHF study. Methods: In this prospective, randomized, multicenter trial, 117 patients (left ventricular ejection fraction [LVEF] ≤ 40%) with mild to moderate CHF were assigned to 2.5mg/5mg/20mg (n=38/36/43) carvedilol groups according to the target dose. Sera were collected at baseline and β1-AAb titer was determined using ELISA. Results: ELISA showed 66 patients as negative and 36/7/7/1 patients as 20-fold (x20) / x40 / x80 / x160 positive, respectively. When the study population was divided into β1-AAb high titer (≥ x40, H) and low titer (≤ x20, L) groups, there were no significant differences in vital signs or cardiac function at baseline between 2 groups. The % change of LVEF during 56 weeks after carvedilol introduction (ΔLVEF) was significantly larger in H than L (H, +85±78% vs. L, +43±65%, p=0.04). LV end-diastolic volume (LVEDV) and end-systolic volume (LVESV) decreased to a greater extent in H than L during 56 weeks (LVEDV, 182±50 to 119±43 ml vs. 202±52 to 167±58 ml, p<0.005 by ANOVA; LVESV, 136±47 to 62±36 ml vs. 141±47 to 97±53 ml, p=0.048 by ANOVA). β1-AAb titer was significantly correlated with ΔLVEF and the % change of LV volume (LVEF, r=0.24, p=0.02; LVEDV, r=-0.26, p=0.02; LVESV r=-0.27, p=0.01). Multiple regression analysis demonstrated that β1-AAb titer was an independent predictor of ΔLVEF and the % changes of LV volume after adjusting for age, gender, allocated dose of carvedilol, heart rate at baseline, plasma BNP at baseline, etiology of CHF and the presence of atrial fibrillation (ΔLVEF β=0.286, p=0.01; ΔLVEDV β=-0.227, p=0.04; ΔLVESV, β=-0.250, p=0.02). Conclusions: The findings in the present study suggested that β1-AAb has a crucial role as one of the determinants of reverse remodeling during carvedilol therapy for patients with CHF.

Mumps antibody response in young adults after a third dose of measles-mumps-rubella vaccine.

Mumps outbreaks in populations with high 2-dose measles-mumps-rubella (MMR) vaccine coverage raise the question whether a third dose of MMR vaccine (MMR3) is needed. However, data on the immunogenicity of MMR3 are limited. We assessed mumps virus neutralizing antibody levels pre- and post-MMR3 in a nonoutbreak setting. Mumps antibody titers were assessed at baseline, 1 month, and 1 year after MMR3 in subjects aged 18-28 years. At baseline, 5 of 656 (0.8%) subjects had seronegative mumps neutralizing antibody titers and 38 (5.8%) had low titers. One year post-MMR3, these numbers declined to 3 (0.5%) and 16 (2.4%), respectively. Subjects with low baseline titers were more likely to have low 1-month and 1-year titers (R (2) = 0.81-0.87, P < .0001). Compared to baseline, geometric mean titers were significantly higher at 1 month (P < .0001) and 1 year (P < .01) post-MMR3; however, reverse cumulative distribution curves showed only minimal shifts in mumps titers from baseline to 1 month and 1 year. Very few subjects had negative or low baseline mumps titers. Nonetheless, mumps titers had modest but significant increases when measured 1 month and 1 year post-MMR3. This temporary increase in titers could decrease susceptibility to disease during outbreaks, but may have limited value for routine use in vaccinated populations.

Study of baseline Widal titres in a healthy adult population of Wayanad district, Kerala, India.

The Widal test is still widely used in diagnosing typhoid fever in developing countries. Often, specific chemotherapy is administered based on a single Widal test. Interpretation of a single Widal test, in turn, depends on the baseline agglutinin titres among the local population in that area. Hence, we aimed to find out the baseline titres in our area. A single blood sample was collected from hospital outpatients with non-infectious diseases, the patients being aged above 18 years and residing in Wayanad district continuously for at least 5 years. The test was performed according to the Widal test kit manufacturer's instructions and interpreted using standard guidelines. The baseline titre for Anti TO, TH, AH and BH agglutinins in our area was found to be 1:40, 1:80, 1:40 and 1:40, respectively.

English

OBJECTIVE: To determine the titers of antibodies against O, H, AH & BH antigens of S.typhi & S. paratypi by Widal test over a 1 year study period among children in a tertiary level hospital. METHODS: This observational study was conducted in the Pediatric wards of a tertiary hospital at Bangalore, Karnataka from 1st January 2013 to December 31st 2013. Children who presented with a history of fever of =/> 7 days were included in the study. These children underwent a Widal test to rule out typhoid fever. A total of 1197 such patients were included in the study. Children with antibody titers more than 1:160 were considered to have enteric fever. RESULTS: Out of the 1197 children, 515 were females & 682 were males. Among females in the age group of /=1:160. Similarly, 5.97%, 6.9% & 7.41% of males in the age group of /=1:160.The titers were similar among the males & the females in all the 3 age groups that were studied. CONCLUSION: The level of antibody titers may vary with time. The highest level of Widal titers of 1:320 against both O & H antigen were found in 3.08%, 2.22% & 1.67% of females in the age group of <2yrs, 2-5 years & 5-18 yrs. Similarly, 1.49%, 3.45% & 1.4% of males in the age group of <2yrs, 2-5 years & 5-18 years had the highest level of titers of 1: 320 against both antigens . Thus there has been an increase in the level of baseline titers against Salmonella species, which needs to be considered while interpreting the results of Widal test for the diagnosis of enteric fever. INTRODUCTION: The term ‘Enteric fever’ covers both typhoid & paratyphoid fevers.(1) It is caused by S. typhi & S. Paratyphi belonging to the family Enterobacteriace. Typhoid & Paratyphoid fevers remain important public health problems globally & major causes of morbidity in the developing world.(2) One study ‘Typhoid fever & Paratyphoid fever: Systemic review to estimate global morbidity & mortality for 2010’ by Geoffrey C Buckle et al, suggests that in 2010, there were an estimated 13.5 million typhoid fever episodes globally & this estimate is comparable to the 2000 crude estimate of 10.8 million episodes published by Crump et al.(2) Lab detection methods for enteric fever include serological tests & cultures. The definitive diagnosis is based on the isolation of organisms on culture. Cultures are not easily available in all areas, especially in developing areas, where incidence of enteric fever is high. Its results are also affected by previous antibiotic usage. Although blood cultures remain gold standard for diagnosis, the poor sensitivity of this method has been acknowledged.(3) Culture positivity varied from 21-50% in a study ‘Enteric fever: a changing perspective’ by N Bismai et al. DOI: 10.14260/jemds/2014/3365

890P - Unimolecular Pentavalent (Globo-H-Gm2-Stn-Tf-Tn) Immunization of Patients (Pts) with Epithelial Ovarian(Eoc), Fallopian Tube, or Peritoneal Cancer in First Remission

ABSTRACT Aim: We conducted an IRB-approved phase I study to evaluate the safety and immunogenicity of a unimolecular pentavalent carbohydrate vaccine, bearing five antigens (AGs), Globo-H, GM2, STn, TF and Tn conjugated to keyhole limpet hemocyanin(KLH) and mixed with QS-21 adjuvant, in EOC pts in 1st remission. We previously demonstrated the safe induction of antibody (ab) responses to these individual AGs in a series of monovalent-KLH trials. Methods: Pts with stage III or IV OC in 1st remission were enrolled from 1/2011-09/2013. Three dose levels were planned (25, 50,100mcg) with 3 cohorts of 6 pts to be treated at each dose level (with an additional expansion cohort of 6 pts at the MTD). The schedule was 5 vaccines administered subcutaneously during weeks 1, 2, 3, 7 and 19. Serologic IgM and IgG responses were measured by ELISA against each AG. Serologic response per AG was defined as 1) Ab titer ≥1:80 for pts with no detectable baseline titer or 2) Ab titer ≥8-fold increase over baseline if detectable baseline titer. If ≥4 of 12 pts treated at the MTD were immune responders for ≥3AGs then the study would be considered positive. Results: n = 24 Median age 56yrs (36-79); 22 (92%) high grade serous; 21 (88%) stage III; 3 (12%) stage IV. No DLTs. Immune Results: IgG +/or IgM: ≥3 AGs 20/24 pts (83%). At MTD 100mcg n = 12: IgG +/or IgM: ≥3 AGs 9/12 pts (75%), ≥4 AGs 7/12 pts (58%), 5 AGs 3/12 pts (25%). IgM: ≥1 AG in pts, ≥3 AGs in pts. IgG: ≥1 AG in pts, ≥3 AGs in pts. With a median follow-up of 19mos (2-39), 8pts (33%) had recurred and 4 pts (17%) had died. Immune Response AG GM2 GM2 GloboH GloboH Tn Tn TF TF sTn sTn Ab IgM IgG IgM IgG IgM IgG IgM IgG IgM IgG n = 12 MTD responders 3 2 1 7 7 10 8 3 11 8 Conclusions: The unimolecular vaccine was shown to be safe and immunogenic. 9/12 (75%) pts at MTD (83% of all treated pts) responded to ≥3 AGs. This immune response was comparable to our previously reported immune response in a phase I trial of a heptavalent vaccine with individual antigens conjugated to KLH. The unimolecular construct warrants further investigation and permits multiple AG-targeting. The construct greatly simplifies manufacturing and allows easy scalability of the vaccine. Disclosure: S. Danishefsky: Dr Danifshesky has financial interest in the vaccine being studied. MSKCC holds the patent on this invention. All other authors have declared no conflicts of interest.

Clinical parameters and biomarkers for anti-TNF treatment prognosis in rheumatoid arthritis patients.

Tumor necrosis factor (TNF) plays a pivotal role in the pathogenesis of rheumatoid arthritis (RA). This finding has led to the development of TNF blockers for RA treatment. However, response to these therapies is heterogeneous with success in only two thirds of patient. Some clinical aspects useful in the attempt to predict the response to TNF inhibitors is the promptness and the magnitude of the response at the first weeks and a low basal disease activity, while comorbidities, tobacco, glucocorticoids treatment, and high basal radiological score correlate with a poorer response. The role of TNF promoter polymorphisms in clinical response to anti-TNF therapies is controversial. A correlation between the presence of high baseline titers of rheumatoid factor (RF) and decreased response to anti-TNF treatment has been reported. Most studies show decreased RF titers during anti-TNF treatment mainly in patients who responded to treatment. There is no consensus about the usefulness of basal anti-citrullinated protein antibodies (ACPA) levels, and a decrease in ACPA titers as predictor of clinical response to anti-TNF therapy. Despite some promising markers identified to fulfill this role, currently the predictive value of single markers seems not strong enough to predict treatment response in an individual RA patient.

Immunogenicity and safety of a single dose of a CRM-conjugated meningococcal ACWY vaccine in children and adolescents aged 2–18 years in Taiwan: Results of an open label study

BackgroundMenACWY-CRM (Menveo®, Novartis Vaccines, Siena, Italy) is a quadrivalent meningococcal conjugate vaccine developed to help prevent invasive meningococcal disease caused by Neisseria meningitidis serogroups A, C, W, and Y. It is approved within the European Union in persons >2 years of age and in persons from 2 months to 55 years of age in the United States, among other countries. Little is known about the immunogenicity and safety of this vaccine in Taiwanese children >2 years and adolescents. This study assessed the immunogenicity and safety of a single injection of MenACWY-CRM vaccine in Taiwanese subjects aged 2–18 years old. MethodsIn this phase III, multicentre, open-label study 341 subjects received one dose of MenACWY-CRM. Immunogenicity measures were rates of seroresponse (defined as the proportion of subjects with a postvaccination hSBA ≥1:8 if the prevaccination (baseline) titre was <1:4, or at least a fourfold higher hSBA titre than baseline if the prevaccination titre was ≥1:4), percentages of subjects with serum bactericidal activity (hSBA) ≥1:8 for serogroups A, C, W and Y and hSBA geometric mean titres (GMTs). Local and systemic reactions and all adverse events (AEs) were recorded for 7 days, and medically attended AEs for 1 month post-vaccination. ResultsSeroresponse rates after MenACWY-CRM vaccination at Day 29 for the serogroups A, C, W, and Y were 83%, 93%, 50%, and 65%, respectively. At Day 29 the percentages of subjects with hSBA ≥1:8 against all four serogroups A, C, W and Y were: 83%, 96%, 96% and 82%, respectively. GMTs against all serogroups rose by ≥7-fold from baseline to Day 29. The vaccine was well tolerated. ConclusionsA single dose of MenACWY-CRM demonstrated a robust immune response, and an acceptable safety profile in Taiwanese children and adolescents.

A1.34 ACPA fine specificity is associated with increased plasmablast numbers and worse clinical response to rituximab in rheumatoid arthritis

BackgroundQuality and duration of response to rituximab in RF/CCP-positive RA is variable. Higher pre-and post-treatment plasmablasts are associated with non/short-response. The objective of this study was to assess the relationship...

Risk Factors for Congenital Syphilis and Adverse Pregnancy Outcomes in Offspring of Women With Syphilis in Shenzhen, China

Despite existence of a highly effective intervention, maternal syphilis still causes substantial perinatal morbidity and mortality, even in China, where antenatal health services are strong. This study sought to address personal, programmatic, and other risk factors for congenital syphilis (CS) and adverse pregnancy outcomes (APOs) among pregnant women in Shenzhen, China. Pregnant women attending antenatal services were offered serologic tests, and those diagnosed as having syphilis were recruited from April 2007 to October 2012. In a nested case-control study for the pregnancy outcomes of syphilis-infected women, we assessed risk factors comparing infants born with CS (group II) and with any APOs (group III) to infants without CS or APOs (group I). During the 66-month study period, we screened 279,334 pregnant women and identified 838 (0.3%; 95% confidence interval, 0.28%-0.32%) women infected with syphilis. Among infants born to syphilitic mothers, 8.2% (34/417) were diagnosed as having CS and 24.7% (103/417) were diagnosed as having APOs. Compared with group I, maternal baseline titers of nontreponemal antibodies (adjusted odds ratio [aOR], 2.13), stage of syphilis (aOR, 21.56), length of time between the end of the first treatment to childbirth (aOR, 11.93), gestational week at treatment (aOR, 2.63), and fathers' cocaine use (aOR, 15.44) and syphilis infection status (aORpositive vs. negative, 5.84; aORunknown vs. negative, 5.55) were positively associated with CS, but prenatal care (aOR, 0.11) and complete treatment (aOR, 0.20) were negatively associated with CS. Maternal age (aOR, 1.43), marriage (aOR, 2.41), history of cocaine use (aOR, 3.79) and ectopic pregnancy (aOR, 5.91), baseline titers of nontreponemal antibodies (aOR, 1.30), stage of syphilis (aOR, 8.89), length of time between the end of the first treatment to childbirth (aOR, 2.52), gestational week at treatment (aOR, 1.78), and fathers' syphilis infection status (aORunknown vs. negative, 2.02) were also positively associated with APOs, but maternal history of syphilis (aOR, 0.44), prenatal care (aOR, 0.29), and complete treatment (aOR, 0.25) were negatively associated with APOs, Syphilis was an important cause of pregnancy loss and infant disability, particularly among women who did not receive prenatal care or had late or inadequate treatment. These study results can inform antenatal programs on the importance of early syphilis testing and prompt and appropriate treatment. Some strategies targeted at other risk factors areas may be helpful.

Impact of the Baseline Anti-A/B Antibody Titer on the Clinical Outcome in ABO-Incompatible Kidney Transplantation

Background/AIMS: We investigated the impact of the baseline anti-A/B antibody titer on the clinical outcome in ABO-incompatible kidney transplantation (IKT). Methods: We included 183 patients who had undergone KT (40 ABO IKT and 143 ABO-compatible KT). Eight patients with a baseline titer of ≥1:512 were assigned to the high-titer group and 32 patients with a baseline titer of ≤1:256 were assigned to the low-titer group. Patients who underwent ABO-compatible KT were used as the control group. We compared the clinical outcomes of the three groups. Results: Before transplantation, the high-titer group displayed more frequent antibody rebound, as shown in a lower titer reduction rate, and more difficulty reaching the target titer (1:16) than the low-titer group. During the postoperative period and out-clinic follow-up, antibody rebound was more frequent, and the rate of acute rejection and infection were significantly higher and allograft function was lower in the high-titer group than in the low-titer and control groups. Multivariate analysis showed that high baseline antibody titer was an independent risk factor for acute rejection. Conclusion: ABO IKT in the high-titer group (baseline titer ≥1:512) required greater caution compared to the low-titer group because of the higher tendency of antibody rebound and the risk for acute rejection.

Safety and Immunogenicity of a Recombinant Tetravalent Dengue Vaccine in 9–16 Year Olds

The dengue virus is a member of the Flavivirus (FV) genus, which also includes the yellow fever virus. Dengue disease is caused by any 1 of 4 dengue virus serotypes and is a serious public health concern in Latin America. This study evaluated the safety and immunogenicity of a candidate recombinant, live-attenuated, tetravalent dengue vaccine (CYD-TDV) in 9-16 year olds in Latin America. In this randomized, blinded, controlled study, volunteers received either 3 doses of CYD-TDV (n = 401) or placebo as first and second injection and tetanus/diphtheria/acellular pertussis vaccine as third injection (n = 199) at 0, 6 and 12 months. Adverse events were documented. Plaque reduction neutralization test antibody titers against the 4 CYD-TDV parental strains were measured before and 28 days after each dose. Seropositivity was defined as antibody titers ≥10 1/dil. The number of adverse reactions decreased after each successive CYD-TDV dose. After each CYD-TDV dose, antibody titers against all 4 serotypes were higher than baseline and respective predose titers. After the third dose of CYD-TDV, 100%, 98.6% and 93.4% of participants were seropositive for at least 2, at least 3 or all 4 serotypes, respectively. Higher antibody titers were observed in participants in the CYD-TDV group who were FV-seropositive at baseline compared with those who were FV-seronegative. CYD-TDV had a favorable safety profile and elicited antibody responses against all 4 dengue virus serotypes in 9-16 year olds in Latin America. These findings support the continued development of CYD-TDV.

Naturally occurring IgG antibody levels to the Staphylococcus aureus protein IsdB in humans

Staphylococcus aureus is a well-recognized, clinically important cause of nosocomial infections, and as such, a vaccine to prevent S. aureus infections would be an important achievement. A Phase IIB/III study of V710, a vaccine containing iron-regulated surface determinant B (IsdB), demonstrated significant sero-conversion rates in cardiovascular surgery patients following a single pre-surgery immunization. However, the vaccine was not efficacious in preventing bacteremia or deep sternal wound infection post-surgery, thus raising the possibility that IsdB might not be available for immune recognition during infection. The purpose of the work described herein was to evaluate and quantify the naturally occurring anti-IsdB levels at baseline and over time during infection, to understand whether IsdB is expressed during a S. aureus infection in hospitalized non-vaccinated patients. We evaluated baseline and follow-up titers in 3 populations: (1) healthy subjects, (2) hospitalized patients with non-S. aureus infections, and (3) hospitalized patients with S. aureus infections. Baseline anti-IsdB levels generally overlapped between the 3 groups, but were highly variable within each group. In healthy subjects, baseline and follow-up levels were highly correlated (Spearman's rho = 0.93), and the geometric mean fold-rise (GMFR) in anti-IsdB levels between study entry and last value was 0.9-fold (95% confidence interval (CI): 0.8 to 1.0 ; p = 0.09), showing no trend over time. The convalescent GMFR in anti-IsdB levels from baseline was 1.7-fold (95% CI: 1.3 to 2.2, p = 0.0008) during S. aureus infection, significantly different from the 1.0-fold GMFR (95% CI: 0.9–1.2, p = 0.60) in non-S. aureus infection, p = 0.005. Additionally, S. aureus isolates (51) obtained from the hospitalized patient group expressed the IsdB protein in vitro. Collectively, these data suggest that IsdB expression levels rise substantially following infection with S. aureus, but not with other pathogens, and IsdB is likely well-conserved across S. aureus strains.

Baseline antibody titres against Salmonella typhi in apparently asymptomatic HIV positive individuals in a tertiary care hospital

Enteric fever is common in tropical regions and is caused by Salmonella enterica serotype typhi (S typhi ). For diagnosis of enteric fever, the Widal test is the most widely used test after blood culture. In HIV infected individuals false positive and false negative Widal reactions are common. The result is variable titres and baseline titres that are unusual in this patient population. This study was done to determine the baseline antibody titres for S typhi among HIV infected individuals. Average baseline antibody titres against O and H antigens of S typhi were measured by standard Widal test in 200 HIV positive asymptomatic individuals, as well as 200 age and sex-matched controls. The results were compiled and statistically analysed. A total of 84 (42%) of the cases had an H antibody titre of >1:20 and 105 (52.5%) had a titre of >1:20 against O antigen. This implies that positive titre of H and O antigen is significantly associated with HIV positive cases with P<0.001. Correlation of CD4 count with antibody titres shows that there is no significant association between CD4 counts and antibody titres against either H (P=0.634) or O antigen (P=0.765). This study shows that HIV infected individuals had increased titres of antibodies against S typhi from the baseline. This indicates a need for evaluation of current cut-off values of diagnostic titres for this group. We also suggest that it is best to perform baseline titres against S t yphi for each patient at the time of diagnosis of HIV status, and to use this for future reference.

Factors associated with serological cure and the serofast state of HIV-negative patients with primary, secondary, latent, and tertiary syphilis.

BackgroundSome syphilis patients remain in a serologically active state after the recommended therapy. We currently know too little about the characteristics of this serological response.MethodsWe conducted a cohort study using the clinical database from Zhongshan Hospital, Medical College of Xiamen. In total, 1,327 HIV-negative patients with primary, secondary, latent, and tertiary syphilis were enrolled. Bivariate and multivariate analyses were utilised to identify factors associated with a serological cure and serofast state in syphilis patients one year after therapy. Chi-square tests were used to determine the differences in the serological cure rate across different therapy time points.ResultsOne year after the recommended therapy, 870 patients achieved a serological cure, and 457 patients (34.4%) remained in the serofast state. The serological cure rate increased only within the first 6 months. The bivariate analysis indicated that male or younger patients had a higher likelihood of a serological cure than female or older patients. Having a baseline titre ≤1∶2 or ≥1∶64 was associated with an increased likelihood of a serological cure. The serological cure rate decreased for the different disease stages in the order of primary, secondary, latent, and tertiary syphilis. A distinction should be drawn between early and late syphilis. The multivariate analysis indicated that a serological cure was significantly associated with the disease phase, gender, age, and baseline rapid plasma reagin (RPR) titre.ConclusionsThe serofast state is common in clinical work. After one year of the recommended therapy, quite a few syphilis patients remained RPR positive. The primary endpoint of the study indicated that disease phase, gender, age and baseline RPR titre were crucial factors associated with a serological cure.

Plasmapheresis as preconditioning protocol in an extremely high titer ABO incompatible renal transplant (ABOiRTx) case: A new prospect for chronic kidney disease patients in India

The biggest hurdle in renal transplantation is the ABO blood group system. But recently ABO incompatible renal transplants have been performed using plasmapheresis (PP) as a part of the preconditioning protocol. In the present study, the objective of PP along with immunosuppression was to bring down the antibody titer of the patient to ⩽16 during the transplant and keep it low, around 32, until post-operative 4–14weeks. The patient (O Negative) had his mother (B Positive) as the ABO non-identical donor. The PP was performed with an apheresis equipment Com.Tec (Fresenius Kabi, Germany) to lower the anti-B antibody titer in the recipient. An Antihuman globulin (AHG) titer was performed for anti-B antibody following the departmental standard operating procedure. A total of 11 plasmapheresis procedures was performed preoperatively and four procedures were performed post-operatively to maintain the titer of the anti-B antibody at or below the desired level. The baseline anti-B antibody titer in the recipient was 512. The baseline titer came down to 8 after the end of the 11th procedure. Post-operatively we performed four plasmapheresis procedures to keep the titer at 32. During the post-operative follow up the titer has been maintained at 32 and the serum creatinine level has been maintained at approximately 1.0mg/dl and other parameters relevant to graft function were within normal limits. Our case could be the first reported case from India in which we used a plasmapheresis procedure as a part of preconditioning protocol instead of using an immunoadsorption column. Furthermore, it could be one of the few ABOiRTx cases, which has been performed at an isoagglutinin titer of 512 using plasma exchange as part of a preconditioning regime.

AB0279 Rheumatoid factor and response to TNF antagonists in rheumatoid arthritis: Systematic review and meta-analysis of observational studies

ObjectivesTo explore whether baseline titer or positivity of rheumatoid factor (RF) are predictors of the response of rheumatoid arhtitis (RA) patients to tumor necrosis (TNF) antagonists.MethodsA systematic review and meta-analysis...

AB0278 The effect of rheumatoid factor titer on the response to TNF antagonists

BackgroundDifferent mechanisms have been proposed to explain the lack of response to TNF antagonists in Rheumatoid Arthritis (RA). These included the potential binding of Rheumatoid Factor (RF) to the Fc...

FRI0227 Acpa fine specificity is associated with increased plasmablast numbers and worse clinical response to rituximab in rheumatoid arthritis

BackgroundQuality and duration of response to rituximab in seropositive RA is variable. Higher pre-and post-treatment plasmablasts are associated with non-response and early relapse, but have not previously been linked to...

SAT0037 14-3-3 ETA Sero-Positivity Marks More Severe Disease and Titres Inform Response to Therapy, also in Patients with Lower Crp

BackgroundThere is an unmet need for RA markers that inform prognosis and treatment response. While RF and anti-CCP are useful, augmenting their predictive capacity with additional markers is desirable. CRP...