ELISA anti-HLA antibody screening identifies non-complement-fixing antibodies responsible for acute graft rejection. A case report.
We report on a kidney transplant recipient experiencing an unexpected early acute vascular graft rejection. Retrospective analysis of patient serum samples, utilizing a new ELISA HLA screening technique, revealed that the rejection crisis and the subsequent graft loss were due to a pretransplant donor-specific pre-sensitization caused by a non-complement-fixing antibody of IgG2 class. The case illustrates the clinical significance of non-complement-fixing anti-HLA antibodies. In addition it is shown that ELISA methods are suitable for detecting potentially harmful donor pre-sensitization in waiting-list patients not detectable by standard lymphocytotoxicity techniques. Hence ELISA could be an alternative to flow cytometry for this purpose. It is concluded that screening and cross-matching techniques which detect non-complement-fixing anti-HLA antibodies could improve graft outcome, and should form part of the immunological monitoring of kidney transplant waiting-list patients.
Institute of Nephrology, St. Orsola University Hospital, Italy.
A
A
Nanni-Costa
M P
MP
Scolari
S
S
Iannelli
A
A
Vangelista
A
A
Buscaroli
G
G
Liviano D'Arcangelo
R
R
Buttazzi
L B
LB
de Sanctis
P
P
Todeschini
S
S
Stefoni
V
V
Bonomini
D000328:Adult; D003168:Complement Fixation Tests; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods*; D006084:Graft Rejection / Q000276:immunology*; D015793:HLA-B7 Antigen / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D012189:Retrospective Studies
D015793:HLA-B7 Antigen; D007074:Immunoglobulin G