Relationship of donor-specific class-I anti-HLA antibodies detected by ELISA after kidney transplantation on the development of acute rejection and graft survival.
BACKGROUND
The objective of this study was to evaluate the role of post-transplant donor-specific anti-HLA antibodies (DS-HLA Abs) detected by an ELISA method on long-term graft survival.


METHODS
The serum pre-/post-transplant profile of anti-HLA Abs was analysed in 71 renal transplant patients by ELISA. The HLA specificity of positive sera was analysed by a different ELISA method. According to the results, patients were classified into two different groups: those who either developed DS-HLA Abs or significantly increased their panel-reactive antibody (PRA) (group A) and those who did not (group B).


RESULTS
Thirteen out of 71 patients showed post-transplant DS-HLA Abs and were included in group A, whereas the remaining 58 were placed in group B. The incidence of acute rejection (AR) was significantly higher in group A than in group B (77 vs 10%). In addition, seven out of eight patients from group A had graft loss secondary to AR, whereas one of nine grafts lost in group B was due to AR. When analysing the clinical outcome according to HLA class specificity, only patients with HLA-I Abs lost their grafts due to vascular AR. The remaining patients with HLA-II Abs who lost their grafts also had HLA-I Abs. In four of the eight patients who lost their grafts, DS HLA-I Abs were detected several days before AR.


CONCLUSIONS
The detection of DS HLA-I Abs in the post-transplant period may provide a good marker for AR and graft loss due to immunological origin. Monitorization of these Abs by ELISA may be a useful tool for tailoring immunosuppression after kidney transplantation.
Fernández-Fresnedo
Gema
G
Nephrology Unit, Marqués de Valdecilla University Hospital, University of Cantabria, E-39008 Santander, Spain.
Pastor
Jose Manuel
JM
López-Hoyos
Marcos
M
Ruiz
Juan Carlos
JC
Zubimendi
Juan Antonio
JA
Gonzalez-Cotorruelo
Julio
J
Rodrigo
Emilio
E
De Francisco
Angel L M
AL
Arias
Manuel
M
D000208:Acute Disease; D000328:Adult; D001803:Blood Transfusion; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D015395:Histocompatibility Antigens Class I / Q000276:immunology; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014019:Tissue Donors
D006680:HLA Antigens; D015395:Histocompatibility Antigens Class I; D007518:Isoantibodies