Poor graft outcome in recipients withde novodonor-specific anti-HLA antibodies after living related kidney transplantation
- 1 December 2008
- journal article
- Published by Frontiers Media SA in Transplant International
- Vol. 21 (12), 1145-1152
- https://doi.org/10.1111/j.1432-2277.2008.00755.x
Abstract
Antibody-mediated rejection (AMR) is now widely recognized as a major problem in organ transplantation. This study was conducted to investigate the relationship between newly developing anti-HLA antibodies post-transplantation (de novo Abs) and the outcome of living related kidney transplantation (LRKT). The subjects included 87 patients who had received living donor kidney allografts at our institution. Panel reactive Ab assay (Flow-PRA) and graft biopsies were performed in all the recipients before and 6 months after the LRKT. The incidence of AMR, the donor specificity and time of appearance of the de novo Abs were retrospectively studied. Among the 87 LRKT recipients, 47 (54%) showed negative/negative (N/N) results, 15 (17%) showed positive/positive (P/P) results, 12 (14%) showed positive/negative results (P/N), and 13 (15%) showed negative/positive (N/P) results (de novo Abs) in the pre-/post-transplant Flow-PRA analysis. Among the 13 cases with de novo Abs, 5 (38%) had donor-specific Abs (DSA) and the remaining 8 (62%) had nondonor-specific Abs, as determined by LAB single antigen analysis. Eighty percent of the recipients with DSA showed evidence of AMR in the graft biopsies. The 5-year graft survival rate of the recipients with de novo Abs (N/P) was 69%, as compared with 96% in the N/N, 88% in the P/N and 93% in the P/P recipient groups (P = 0.009). LRKT recipients developing de novo Abs, especially those with DSA, showed a much higher incidence of AMR and a worse prognosis. Cautious monitoring for the appearance of anti-HLA Abs should be adopted after transplantation, even in patients without anti-HLA Abs prior to the transplantation.Keywords
This publication has 30 references indexed in Scilit:
- Banff ’05 Meeting Report: Differential Diagnosis of Chronic Allograft Injury and Elimination of Chronic Allograft Nephropathy (’CAN’)American Journal of Transplantation, 2007
- Evaluation of Immunosuppressive Regimens in ABO-Incompatible Living Kidney Transplantation—Single Center AnalysisAmerican Journal of Transplantation, 2007
- Clinical Relevance of Anti-HLA Antibodies Detected by Flow-Cytometry Bead-Based Assays—Single-Center ExperienceHuman Immunology, 2006
- Alloantibodies and the Outcome of Cadaver Kidney AllograftsHuman Immunology, 2006
- Transplantation across previously incompatible immunological barriersTransplant International, 2006
- Effect of donor-specific transfusions on the outcome of renal allografts in the cyclosporine eraTransplant International, 2006
- Ultra‐Late Antibody‐Mediated Rejection 30 Years After a Living‐Related Renal AllograftAmerican Journal of Transplantation, 2005
- Evaluation of flow cytometric panel reactive antibody in renal transplant recipients - examination of 238 cases of renal transplantationTransplant International, 2005
- The Banff 97 working classification of renal allograft pathologyKidney International, 1999
- IDENTIFICATION OF PATIENTS AT HIGH RISK OF GRAFT LOSS BY PRE- AND POSTTRANSPLANT MONITORING OF ANTI-HLA CLASS I IgG ANTIBODIES BY ENZYME-LINKED IMMUNOSORBENT ASSAYTransplantation, 1997