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Article ; Online: Acute Pancreatitis: Diagnosis and Treatment.

Szatmary, Peter / Grammatikopoulos, Tassos / Cai, Wenhao / Huang, Wei / Mukherjee, Rajarshi / Halloran, Chris / Beyer, Georg / Sutton, Robert

Drugs

2022 Volume 82, Issue 12, Page(s) 1251–1276

Abstract: Acute pancreatitis is a common indication for hospital admission, increasing in incidence, including in children, pregnancy and the elderly. Moderately severe acute pancreatitis with fluid and/or necrotic collections causes substantial morbidity, and ... ...

Abstract	Acute pancreatitis is a common indication for hospital admission, increasing in incidence, including in children, pregnancy and the elderly. Moderately severe acute pancreatitis with fluid and/or necrotic collections causes substantial morbidity, and severe disease with persistent organ failure causes significant mortality. The diagnosis requires two of upper abdominal pain, amylase/lipase ≥ 3 ×upper limit of normal, and/or cross-sectional imaging findings. Gallstones and ethanol predominate while hypertriglyceridaemia and drugs are notable among many causes. Serum triglycerides, full blood count, renal and liver function tests, glucose, calcium, transabdominal ultrasound, and chest imaging are indicated, with abdominal cross-sectional imaging if there is diagnostic uncertainty. Subsequent imaging is undertaken to detect complications, for example, if C-reactive protein exceeds 150 mg/L, or rarer aetiologies. Pancreatic intracellular calcium overload, mitochondrial impairment, and inflammatory responses are critical in pathogenesis, targeted in current treatment trials, which are crucially important as there is no internationally licenced drug to treat acute pancreatitis and prevent complications. Initial priorities are intravenous fluid resuscitation, analgesia, and enteral nutrition, and when necessary, critical care and organ support, parenteral nutrition, antibiotics, pancreatic exocrine and endocrine replacement therapy; all may have adverse effects. Patients with local complications should be referred to specialist tertiary centres to guide further management, which may include drainage and/or necrosectomy. The impact of acute pancreatitis can be devastating, so prevention or reduction of the risk of recurrence and progression to chronic pancreatitis with an increased risk of pancreas cancer requires proactive management that should be long term for some patients.
MeSH term(s)	Acute Disease ; Aged ; Amylases ; Anti-Bacterial Agents/therapeutic use ; C-Reactive Protein ; Calcium ; Child ; Ethanol ; Glucose ; Humans ; Lipase ; Pancreatitis/diagnosis ; Pancreatitis/etiology ; Pancreatitis/therapy ; Triglycerides
Chemical Substances	Anti-Bacterial Agents ; Triglycerides ; Ethanol (3K9958V90M) ; C-Reactive Protein (9007-41-4) ; Lipase (EC 3.1.1.3) ; Amylases (EC 3.2.1.-) ; Glucose (IY9XDZ35W2) ; Calcium (SY7Q814VUP)
Language	English
Publishing date	2022-09-08
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	120316-2
ISSN	1179-1950 ; 0012-6667
ISSN (online)	1179-1950
ISSN	0012-6667
DOI	10.1007/s40265-022-01766-4
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Zs.A 762: Show issues

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Article ; Online: Monocytic HLA-DR Expression in Immune Responses of Acute Pancreatitis and COVID-19.

Liu, Shiyu / Luo, Wenjuan / Szatmary, Peter / Zhang, Xiaoying / Lin, Jing-Wen / Chen, Lu / Liu, Dan / Sutton, Robert / Xia, Qing / Jin, Tao / Liu, Tingting / Huang, Wei

International journal of molecular sciences

2023 Volume 24, Issue 4

Abstract: Acute pancreatitis is a common gastrointestinal disease with increasing incidence worldwide. COVID-19 is a potentially life-threatening contagious disease spread throughout the world, caused by severe acute respiratory syndrome coronavirus 2. More severe ...

Abstract	Acute pancreatitis is a common gastrointestinal disease with increasing incidence worldwide. COVID-19 is a potentially life-threatening contagious disease spread throughout the world, caused by severe acute respiratory syndrome coronavirus 2. More severe forms of both diseases exhibit commonalities with dysregulated immune responses resulting in amplified inflammation and susceptibility to infection. Human leucocyte antigen (HLA)-DR, expressed on antigen-presenting cells, acts as an indicator of immune function. Research advances have highlighted the predictive values of monocytic HLA-DR (mHLA-DR) expression for disease severity and infectious complications in both acute pancreatitis and COVID-19 patients. While the regulatory mechanism of altered mHLA-DR expression remains unclear, HLA-DR
MeSH term(s)	Humans ; Pancreatitis ; Acute Disease ; COVID-19 ; HLA-DR Antigens ; Monocytes ; Immunity
Chemical Substances	HLA-DR Antigens
Language	English
Publishing date	2023-02-07
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms24043246
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Article ; Online: Biology, role and therapeutic potential of circulating histones in acute inflammatory disorders.

Szatmary, Peter / Huang, Wei / Criddle, David / Tepikin, Alexei / Sutton, Robert

Journal of cellular and molecular medicine

2018 Volume 22, Issue 10, Page(s) 4617–4629

Abstract: Histones are positively charged nuclear proteins that facilitate packaging of DNA into nucleosomes common to all eukaryotic cells. Upon cell injury or cell signalling processes, histones are released passively through cell necrosis or actively from ... ...

Abstract	Histones are positively charged nuclear proteins that facilitate packaging of DNA into nucleosomes common to all eukaryotic cells. Upon cell injury or cell signalling processes, histones are released passively through cell necrosis or actively from immune cells as part of extracellular traps. Extracellular histones function as microbicidal proteins and are pro-thrombotic, limiting spread of infection or isolating areas of injury to allow for immune cell infiltration, clearance of infection and initiation of tissue regeneration and repair. Histone toxicity, however, is not specific to microbes and contributes to tissue and end-organ injury, which in cases of systemic inflammation may lead to organ failure and death. This review details the processes of histones release in acute inflammation, the mechanisms of histone-related tissue toxicity and current and future strategies for therapy targeting histones in acute inflammatory diseases.
MeSH term(s)	Alarmins/blood ; Alarmins/genetics ; Alarmins/immunology ; Anti-Inflammatory Agents/therapeutic use ; Blood Coagulation Factors/genetics ; Blood Coagulation Factors/immunology ; Chemotactic Factors/blood ; Chemotactic Factors/genetics ; Chemotactic Factors/immunology ; Chemotaxis/immunology ; Communicable Diseases/genetics ; Communicable Diseases/immunology ; Communicable Diseases/pathology ; Communicable Diseases/therapy ; Extracellular Space/chemistry ; Extracellular Space/immunology ; Extracellular Traps/chemistry ; Extracellular Traps/immunology ; Gene Expression Regulation ; Histones/blood ; Histones/genetics ; Histones/immunology ; Humans ; Immunity, Innate ; Inflammation ; Necrosis/genetics ; Necrosis/immunology ; Necrosis/pathology ; Necrosis/therapy ; Neutrophils ; Receptors, Pattern Recognition/genetics ; Receptors, Pattern Recognition/immunology ; Signal Transduction ; Thrombosis/genetics ; Thrombosis/immunology ; Thrombosis/pathology ; Thrombosis/therapy
Chemical Substances	Alarmins ; Anti-Inflammatory Agents ; Blood Coagulation Factors ; Chemotactic Factors ; Histones ; Receptors, Pattern Recognition
Language	English
Publishing date	2018-08-07
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2074559-X
ISSN	1582-4934 ; 1582-4934 ; 1582-1838
ISSN (online)	1582-4934
ISSN	1582-4934 ; 1582-1838
DOI	10.1111/jcmm.13797
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Article ; Online: Defined, low threshold for caesarean section and multidisciplinary team management improves fetal outcome from acute pancreatitis in pregnancy.

He, Wenhua / Zhang, Zhi / Cai, Wenhao / Luo, Lingyu / Xu, Hongrong / Li, Lei / Li, Jiarong / Xia, Liang / Zhu, Yong / Liu, Pi / Zeng, Hao / Cao, Chunshui / Chen, Haiming / Yuan, Gaole / Yu, Chen / Wan, Junhui / Szatmary, Peter / Sutton, Robert / Zhu, Yin /

Lu, Nonghua

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.

2023 Volume 23, Issue 5, Page(s) 473–480

Abstract: Background: Acute pancreatitis in pregnancy (APIP) is associated with increased maternal and fetal mortality.: Objectives: We sought to determine whether a low threshold for cesarean section (C-section) in severe acute pancreatitis (SAP) or Predict ... ...

Abstract	Background: Acute pancreatitis in pregnancy (APIP) is associated with increased maternal and fetal mortality. Objectives: We sought to determine whether a low threshold for cesarean section (C-section) in severe acute pancreatitis (SAP) or Predict SAP improves maternal and fetal outcomes in patients with APIP. Methods: We identified patients with APIP at a single institution from a prospective database and studied fetal and maternal health in APIP before (2005-2014) and after (2015-2019) introduction of multidisciplinary team management with a defined, lowered threshold for C-section. The primary end point was fetal mortality comprising abortion and perinatal death. Risk factors associated with fetal mortality were analyzed by univariable and multivariable logistic regression analysis. Results: A total of 165 patients with APIP were eligible for analysis. There was a highly significant increase in patients undergoing C-section from 37 (30.8%) of 120 during 2005-2014 to 27 (60%) of 45 in 2015-2019 (P = 0.001), with a highly significant fall in fetal mortality from 37 (30.8%) of 120 to 3 (6.7%) of 45 between the same periods (P = 0.001), when maternal mortality fell from 6 to zero (P = 0.19). Maternal early systemic inflammatory response syndrome (SIRS) (odds ratio [OR] 6.98, 95% confidence interval [CI] 1.53, 30.80, P = 0.01) and SAP (OR 3.64, 95%CI 1.25, 10.60, P = 0.02) were two independent risk factors associated with fetal mortality. Conclusions: Multidisciplinary collaboration and a defined, low threshold for C-section improve fetal outcomes in patients with APIP.
MeSH term(s)	Pregnancy ; Humans ; Female ; Pancreatitis/complications ; Cesarean Section/adverse effects ; Acute Disease ; Patient Care Team
Language	English
Publishing date	2023-05-21
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2056680-3
ISSN	1424-3911 ; 1424-3903
ISSN (online)	1424-3911
ISSN	1424-3903
DOI	10.1016/j.pan.2023.05.009
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Zs.A 5553: Show issues

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Article: Predicting the Need for Therapeutic Intervention and Mortality in Acute Pancreatitis: A Two-Center International Study Using Machine Learning.

Shi, Na / Lan, Lan / Luo, Jiawei / Zhu, Ping / Ward, Thomas R W / Szatmary, Peter / Sutton, Robert / Huang, Wei / Windsor, John A / Zhou, Xiaobo / Xia, Qing

Journal of personalized medicine

2022 Volume 12, Issue 4

Abstract: Background: Current approaches to predicting intervention needs and mortality have reached 65-85% accuracy, which falls below clinical decision-making requirements in patients with acute pancreatitis (AP). We aimed to accurately predict therapeutic ... ...

Abstract	Background: Current approaches to predicting intervention needs and mortality have reached 65-85% accuracy, which falls below clinical decision-making requirements in patients with acute pancreatitis (AP). We aimed to accurately predict therapeutic intervention needs and mortality on admission, in AP patients, using machine learning (ML). Methods: Data were obtained from three databases of patients admitted with AP: one retrospective (Chengdu) and two prospective (Liverpool and Chengdu) databases. Intervention and mortality differences, as well as potential predictors, were investigated. Univariate analysis was conducted, followed by a random forest ML algorithm used in multivariate analysis, to identify predictors. The ML performance matrix was applied to evaluate the model's performance. Results: Three datasets of 2846 patients included 25 potential clinical predictors in the univariate analysis. The top ten identified predictors were obtained by ML models, for predicting interventions and mortality, from the training dataset. The prediction of interventions includes death in non-intervention patients, validated with high accuracy (96%/98%), the area under the receiver-operating-characteristic curve (0.90/0.98), and positive likelihood ratios (22.3/69.8), respectively. The post-test probabilities in the test set were 55.4% and 71.6%, respectively, which were considerably superior to existing prognostic scores. The ML model, for predicting mortality in intervention patients, performed better or equally with prognostic scores. Conclusions: ML, using admission clinical predictors, can accurately predict therapeutic interventions and mortality in patients with AP.
Language	English
Publishing date	2022-04-11
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662248-8
ISSN	2075-4426
ISSN	2075-4426
DOI	10.3390/jpm12040616
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Article ; Online: Early postoperative arterial lactate concentrations to stratify risk of post-hepatectomy liver failure.

Niederwieser, Thomas / Braunwarth, Eva / Dasari, Bobby V M / Pufal, Kamil / Szatmary, Peter / Hackl, Hubert / Haselmann, Clemens / Connolly, Catherine E / Cardini, Benno / Öfner, Dietmar / Roberts, Keith / Malik, Hassan / Stättner, Stefan / Primavesi, Florian

The British journal of surgery

2022 Volume 108, Issue 11, Page(s) 1360–1370

Abstract: Background: Post-hepatectomy liver failure (PHLF) represents the major determinant for death after liver resection. Early recognition is essential. Perioperative lactate dynamics for risk assessment of PHLF and associated morbidity were evaluated.: ... ...

Abstract	Background: Post-hepatectomy liver failure (PHLF) represents the major determinant for death after liver resection. Early recognition is essential. Perioperative lactate dynamics for risk assessment of PHLF and associated morbidity were evaluated. Methods: This was a multicentre observational study of patients undergoing hepatectomy with validation in international high-volume units. Receiver operating characteristics analysis and cut-off calculation for the predictive value of lactate for clinically relevant International Study Group of Liver Surgery grade B/C PHLF (clinically relevant PHLF (CR-PHLF)) were performed. Lactate and other perioperative factors were assessed in a multivariable CR-PHLF regression model. Results: The exploratory cohort comprised 509 patients. CR-PHLF, death, overall morbidity and severe morbidity occurred in 7.7, 3.3, 40.9 and 29.3 per cent of patients respectively. The areas under the curve (AUCs) regarding CR-PHLF were 0.829 (95 per cent c.i. 0.770 to 0.888) for maximum lactate within 24 h (Lactate_Max) and 0.870 (95 per cent c.i. 0.818 to 0.922) for postoperative day 1 levels (Lactate_POD1). The respective AUCs in the validation cohort (482 patients) were 0.812 and 0.751 and optimal Lactate_Max cut-offs were identical in both cohorts. Exploration cohort patients with Lactate_Max 50 mg/dl or greater more often developed CR-PHLF (50.0 per cent) than those with Lactate_Max between 20 and 49.9 mg/dl (7.4 per cent) or less than 20 mg/dl (0.5 per cent; P < 0.001). This also applied to death (18.4, 2.7 and 1.4 per cent), severe morbidity (71.1, 35.7 and 14.1 per cent) and associated complications such as acute kidney injury (26.3, 3.1 and 2.3 per cent) and haemorrhage (15.8, 3.1 and 1.4 per cent). These results were confirmed in the validation group. Combining Lactate_Max with Lactate_POD1 further increased AUC (ΔAUC = 0.053) utilizing lactate dynamics for risk assessment. Lactate_Max, major resections, age, cirrhosis and chronic kidney disease were independent risk factors for CR-PHLF. A freely available calculator facilitates clinical risk stratification (www.liver-calculator.com). Conclusion: Early postoperative lactate values are powerful, readily available markers for CR-PHLF and associated complications after hepatectomy with potential for guiding postoperative care.Presented in part as an oral video abstract at the 2020 online Congress of the European Society for Surgical Research and the 2021 Congress of the Austrian Surgical Society.
MeSH term(s)	Aged ; Austria/epidemiology ; Biomarkers/blood ; Female ; Hepatectomy/adverse effects ; Humans ; Incidence ; Lactic Acid/blood ; Liver Failure/blood ; Liver Failure/epidemiology ; Male ; Middle Aged ; Postoperative Complications/blood ; Postoperative Complications/epidemiology ; Prognosis ; Retrospective Studies ; Risk Assessment/methods ; Risk Factors
Chemical Substances	Biomarkers ; Lactic Acid (33X04XA5AT)
Language	English
Publishing date	2022-01-04
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znab338
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Article ; Online: Emerging Phenotype of Severe Acute Respiratory Syndrome-Coronavirus 2-associated Pancreatitis.

Szatmary, Peter / Arora, Ankur / Thomas Raraty, Michael Godwin / Joseph Dunne, Declan Francis / Baron, Ryan David / Halloran, Christopher Michael

Gastroenterology

2020 Volume 159, Issue 4, Page(s) 1551–1554

MeSH term(s)	Adult ; Amylases/blood ; Betacoronavirus ; C-Reactive Protein/metabolism ; COVID-19 ; Contrast Media ; Coronavirus Infections/complications ; Humans ; Male ; Middle Aged ; Pancreatitis/blood ; Pancreatitis/diagnostic imaging ; Pancreatitis/virology ; Pandemics ; Phenotype ; Pneumonia, Viral/complications ; Retrospective Studies ; SARS-CoV-2 ; Tomography, X-Ray Computed
Chemical Substances	Contrast Media ; C-Reactive Protein (9007-41-4) ; Amylases (EC 3.2.1.-)
Keywords	covid19
Language	English
Publishing date	2020-06-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	80112-4
ISSN	1528-0012 ; 0016-5085
ISSN (online)	1528-0012
ISSN	0016-5085
DOI	10.1053/j.gastro.2020.05.069
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Article ; Online: Regulating the expression of CD80/CD86 on dendritic cells to induce immune tolerance after xeno-islet transplantation.

Ke, Nengwen / Su, Anping / Huang, Wei / Szatmary, Peter / Zhang, Zhaoda

Immunobiology

2016 Volume 221, Issue 7, Page(s) 803–812

Abstract: Background: Antigen present cells (APCs) have been demonstrated to play dual roles in immune tolerance. Recently, compelling evidence indicates that APCs that express CD80, but not CD86 can protect allograft. We investigated whether modulation of CD80 ... ...

Abstract	Background: Antigen present cells (APCs) have been demonstrated to play dual roles in immune tolerance. Recently, compelling evidence indicates that APCs that express CD80, but not CD86 can protect allograft. We investigated whether modulation of CD80 in dendritic cells (DCs) offer protection for xeno-islets. Methods: In vitro, isolated mature murine DCs received untransfection, transfection with CD86 siRNA or negative control siRNA. The DCs were used in mixed lymphocyte reaction in which rat islets and murine splenocytes were further added. On day 3 of co-culturing, the proliferation of lymphocytes was measured and interleukin (IL)-2, IL-4, IL-10, transforming growth factor β (TGF-β), interferon γ (INF-γ) and indoleamine 2,3-dioxygenase (IDO) from the supernatants were determined. Islets viability and function were also assessed. In vivo, streptozotocin-induced diabetic mice underwent rat islets transplantation were pre-treated with above DCs. At designated time, xeno-islets were subjected to histopathology, immunohistochemistry, survival time and functional tests. Peripheral blood T lymphocyte profiles were also examined. Results: CD86-silenced-DCs had unchanged expression of CD80 and significantly suppressed the proliferation of lymphocytes. CD86-silenced-DCs simultaneously reduced IL-2 and INF-γ and increased IL-10, TGF-β and IDO, while had minimal effect on IL-4. The CD86-silenced-DCs also improved cell viability and function of xeno-islets when compared to untransfection and transfection control groups. In xeno-islets transplanted diabetic mice, transfer of CD86-silenced-DCs resulted in improved histopathology and dramatically prolonged survival time of the islets. These effects were also mirrored by the functional tests. Further analysis revealed that CD86-silenced-DCs had up-regulated levels of CD4(+)CD25(+)T cells in the peripheral blood compared to the other groups. Conclusions: CD86-silenced-DCs induced immune tolerance of rat xeno-islets in recipient diabetic mice with up-regulated peripheral blood CD4(+)CD25(+)T cells.
Language	English
Publishing date	2016-07
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	563292-4
ISSN	1878-3279 ; 0171-2985
ISSN (online)	1878-3279
ISSN	0171-2985
DOI	10.1016/j.imbio.2016.02.002
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Article: Clinical characteristics and long-term outcomes following pancreatic injury - An international multicenter cohort study.

Heliyon

2023 Volume 9, Issue 6, Page(s) e17436

Abstract: Background: Trauma to the pancreas is rare but associated with significant morbidity. Currently available management guidelines are based on low-quality evidence and data on long-term outcomes is lacking. This study aimed to evaluate clinical ... ...

Abstract	Background: Trauma to the pancreas is rare but associated with significant morbidity. Currently available management guidelines are based on low-quality evidence and data on long-term outcomes is lacking. This study aimed to evaluate clinical characteristics and patient-reported long-term outcomes for pancreatic injury. Methods: A retrospective cohort study evaluating treatment for pancreatic injury in 11 centers across 5 European nations over >10 years was performed. Data relating to pancreatic injury and treatment were collected from hospital records. Patients reported quality of life (QoL), changes to employment and new or ongoing therapy due to index injury. Results: In all, 165 patients were included. The majority were male (70.9%), median age was 27 years (range: 6-93) and mechanism of injury predominantly blunt (87.9%). A quarter of cases were treated conservatively; higher injury severity score (ISS) and American Association for the Surgery of Trauma (AAST) pancreatic injury scores increased the likelihood for surgical, endoscopic and/or radiologic intervention. Isolated, blunt pancreatic injury was associated with younger age and pancreatic duct involvement; this cohort appeared to benefit from non-operative management. In the long term (median follow-up 93; range 8-214 months), exocrine and endocrine pancreatic insufficiency were reported by 9.3% of respondents. Long-term analgesic use also affected 9.3% of respondents, with many reported quality of life problems (QoL) potentially attributable to side-effects of opiate therapy. Overall, impaired QoL correlated with higher ISS scores, surgical therapy and opioid analgesia on discharge. Conclusions: Pancreatic trauma is rare but can lead to substantial short- and long-term morbidity. Near complete recovery of QoL indicators and pancreatic function can occur despite significant injury, especially in isolated, blunt pancreatic injury managed conservatively and when early weaning off opiate analgesia is achieved.
Language	English
Publishing date	2023-06-21
Publishing country	England
Document type	Journal Article
ZDB-ID	2835763-2
ISSN	2405-8440
ISSN	2405-8440
DOI	10.1016/j.heliyon.2023.e17436
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Article: Impact of sensitivity of human leucocyte antigen antibody detection by Luminex technology on graft loss at 1 year.

Szatmary, Peter / Jones, James / Hammad, Abdul / Middleton, Derek

Clinical kidney journal

2013 Volume 6, Issue 3, Page(s) 283–286

Abstract: Background: The clinical relevance of the detection of human leucocyte antigen (HLA) antibodies in sera of renal transplant recipients by highly sensitive methods such as Luminex alone is uncertain and a matter of debate. The choice of output thresholds ...

Abstract	Background: The clinical relevance of the detection of human leucocyte antigen (HLA) antibodies in sera of renal transplant recipients by highly sensitive methods such as Luminex alone is uncertain and a matter of debate. The choice of output thresholds affects antibody detection and thus organ allocation, yet there are no internationally agreed threshold levels. This study aims at evaluating our current practice of using an MFI threshold of 1000 in antibody detection. Methods: We carried out a case-control study by looking at 761 renal transplant recipients at one unit between 2000 and 2010. Of these, there were 93 cases of graft loss within 1 year and stored serum samples of 40 cases were available for testing. Controls were selected (graft function >2 years) and individually matched according to age, sex, number of transplants and date of transplant. All 40 cases and 40 controls had negative crossmatch by complement-dependent cytotoxicity (CDC) at the time of transplant, and pre-transplant sera were re-analysed for the presence of detectable HLA and donor-specific antibodies (DSAs) using Luminex screen and single-antigen beads and MFI threshold values of 1000, 2000 and 4000. Results: In nearly 48% of cases with graft loss within a year, HLA antibodies were detectable by Luminex when using a 1000 MFI threshold. This was 25% greater than in controls (P = 0.017). There was also a 15% increase in detected DSAs; however, statistical significance depends on the inclusion or exclusion of one specific case. Using MFI thresholds of 2000 and 4000, no DSAs were found in any long-term surviving grafts. Conclusions: Selection of appropriate MFI cut-off values influences the detection of DSAs and, thus, organ allocation. Using a threshold of 1000 led to the detection of DSAs in 5% of long-term graft survivors in our population and should be considered too sensitive. Using a detection threshold of 2000 is sufficiently sensitive and leads to clinically relevant detection of DSA.
Language	English
Publishing date	2013-03-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2655800-2
ISSN	2048-8513 ; 2048-8505
ISSN (online)	2048-8513
ISSN	2048-8505
DOI	10.1093/ckj/sft037
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