Immunomodulation of kidney and heart transplants by anti-idiotypic antibodies.
To explore the possibility that circulating HLA antigens from the graft and anti-anti-HLA (anti-idiotypic) antibodies influence the long-term survival of renal and cardiac allografts, analysis of 330 renal allograft recipients and 174 recipients of cardiac allografts was conducted. Anti-donor-HLA antibodies (Ab1) present before or after transplantation are associated with graft failure, whereas irrelevant anti-HLA antibodies had no impact on actuarial graft survival. Ab1 may be uncovered by dissociation of immune complexes and depletion of soluble antigens with monoclonal antibody-coated magnetic beads. Of the 421 sera tested from 65 heart recipients, 97 showed Ab1 before depletion and 178 after depletion; similar rise in positive sera was seen in 39 renal transplant recipients. Three distinct patterns of appearance of Ab1 and Ab2 (anti-Ab1 antibody) were recognized. Patients with cyclic variations of Ab1 in association with Ab2 had 100% graft survival, whereas patients with cyclic variations of Ab1 but no detectable Ab2 had 2-year graft survival of 36% for kidneys and 71% for hearts. Presence of Ab1 in all sera after transplantation led to 47% and 56% 2-year renal and heart allograft survival, respectively.
Hardy
M A
MA
Columbia University College of Physicians and Surgeons, Department of Surgery, New York, NY 10032.
Suciu-Foca
N
N
Reed
E
E
Benvenisty
A I
AI
Smith
C
C
Rose
E
E
Reemtsma
K
K
D000206:Actuarial Analysis; D000906:Antibodies / Q000097:blood / Q000276:immunology; D000888:Antibodies, Anti-Idiotypic / Q000097:blood* / Q000502:physiology; D005500:Follow-Up Studies; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000097:blood / Q000276:immunology*; D016027:Heart Transplantation / Q000276:immunology* / Q000401:mortality; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D011184:Postoperative Period; D015996:Survival Rate; D013997:Time Factors
D000906:Antibodies; D000888:Antibodies, Anti-Idiotypic; D006680:HLA Antigens