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October 13, 2014

Dynamics of anti-human leukocyte antigen antibodies after renal transplantation and their impact on graft outcome

De Souza PS, David-Neto E, Panajotopolous N, et al.

 

Keywords:

antibody-mediated rejection;anti-HLA antibodies;graft function;graft survival

 

Abstract:

The purpose of this study was to sequentially monitor anti-HLA antibodies and correlate the results with antibody-mediated rejection (AMR), graft survival (GS), and graft function (GF). We collected sera from 111 kidney transplant recipients on transplant days 0, 7, 14, 30, 60, 90, 180, and 360 and analyzed PRA levels by ELISA. DSAs were analyzed by single-antigen beads in rejecting kidneys. At pre-transplant, 79.3% of the patients were non-sensitized (PRA = 0%) and 20.7% were sensitized (PRA > 1%). After transplant, patients were grouped by PRA profile: no anti-HLA antibodies pre- or post-transplant (group HLApre−/post−; n = 80); de novo anti-HLA antibodies post-transplant (group HLApre−/post+; n = 8); sensitized pre-transplant/increased PRA post-transplant (group HLApre+/post[UPWARDS ARROW]; n = 9); and sensitized pre-transplant/decreased PRA post-transplant (group HLApre+/post[DOWNWARDS ARROW]; n = 14). De novo anti-HLA antibodies were detected at 7–180 d. In sensitized patients, PRA levels changed within the first 30 d post-transplant. Incidence of AMR was higher in HLApre−/post+ and HLApre+/post[UPWARDS ARROW] than in HLApre−/post−, and HLApre+/post[DOWNWARDS ARROW] (p < 0.001) groups. One-yr death-censored GS was 36% in group HLApre+/post[UPWARDS ARROW], compared with 98%, 88% and 100% in groups HLApre−/post−, HLApre−/post+, and HLApre+/post[DOWNWARDS ARROW], respectively (p < 0.001). Excluding first-year graft losses, GF and GS were similar among the groups. In conclusion, post-transplant antibody monitoring can identify recipients at higher risk of AMR.
 

Epub: 9/22/2014

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