title: All chronic rejection failures of kidney transplants were preceded by the development of HLA antibodies.
abstract: BACKGROUND
  Recent studies show that almost all patients who have rejected a kidney transplant had human leukocyte antigen (HLA) antibodies. In this study, we sought to determine whether patients develop HLA antibodies before chronic rejection.
  
  
  METHODS
  For the past 8 years, 139 patients who had undergone kidney transplantation were systematically examined, using an enzyme-linked immunosorbent assay-based method, for the development of class-I and class-II HLA antibodies 3 months, 6 months, and yearly after transplantation. Chronic rejection was diagnosed by biopsy.
  
  
  RESULTS
  Among 29 patients with chronic rejection, 100% of the patients had HLA antibodies before rejection. Of these patients, 14 patients developed antibodies de novo. In contrast, among 110 patients with stable function, 27% of the patients developed HLA antibodies posttransplant (P<0.001).
  
  
  CONCLUSIONS
  HLA antibodies were found in 29 consecutive cases of chronic rejection failures as much as one year before the loss of grafts. We conclude that HLA antibodies may be a prerequisite for chronic immunologic rejection.
authors.affiliation: Department of Surgery, Medical College, University Hospital, National Cheng Kung University, 138 Sheng-Li Road, Tainan, Taiwan 704. pochang@mail.ncku.edu.tw
authors.forename: Po-Chang
authors.initials: PC
authors.lastname: Lee
authors.forename: Paul I
authors.initials: PI
authors.lastname: Terasaki
authors.forename: Steven K
authors.initials: SK
authors.lastname: Takemoto
authors.forename: Po-Huang
authors.initials: PH
authors.lastname: Lee
authors.forename: Chung-Jye
authors.initials: CJ
authors.lastname: Hung
authors.forename: Yi-Lin
authors.initials: YL
authors.lastname: Chen
authors.forename: Alen
authors.initials: A
authors.lastname: Tsai
authors.forename: Huan-Yao
authors.initials: HY
authors.lastname: Lei
mesh_terms: D001323:Autoantibodies / Q000097:blood*; D002908:Chronic Disease; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure
chemical_list: D001323:Autoantibodies; D006680:HLA Antigens