ATG induction is associated with an increase in anti-HLA antibodies after kidney transplantation.
Anti-human histocompatibility antigen antibodies (HLA-Ab) are deleterious after kidney transplant and may be increased after T-cell depleting agents are given. A retrospective case control study was conducted to evaluate increase in HLA-Ab in 27 kidney transplant recipients who had received antithymocyte globulin (ATG) induction compared with 27 control subjects. A greater than 10% increase in class I or class II HLA-Ab was found in 6 (22.2%) of ATG subjects versus only 1 (3.7%) of non-ATG subjects (p = 0.05). In females, 6/14 ATG subjects developed increased HLA-Ab > or =10% compared with none of the control subjects (p = 0.016). In sensitized subjects, 4/10 in the ATG group developed increased HLA-Ab > or =10% versus none of the controls (p = 0.043). There was no difference in number or severity of acute rejection episodes or estimated glomerular filtration rate 6 months after transplant between the two treatment groups. We conclude that ATG induction may result in increased posttransplant HLA-Ab, particularly in subjects at higher immunologic risk. Further studies are necessary to determine the natural history, clinical consequences, appropriate therapy, and mechanisms responsible for HLA-Ab in this setting.
Tinckam
Kathryn J
KJ
Renal Division, Brigham and Women's Hospital, Harvard University, Boston, MA 02115, USA. ktinckam@rics.bwh.harvard.edu
Wood
Isabelle G
IG
Ji
Fang
F
Milford
Edgar L
EL
D000818:Animals; D000906:Antibodies / Q000097:blood* / Q000276:immunology; D000961:Antilymphocyte Serum / Q000009:adverse effects / Q000276:immunology*; D016022:Case-Control Studies; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006681:HLA-D Antigens / Q000097:blood / Q000276:immunology; D015395:Histocompatibility Antigens Class I / Q000097:blood / Q000276:immunology; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011817:Rabbits; D012189:Retrospective Studies; D012737:Sex Factors
D000906:Antibodies; D000961:Antilymphocyte Serum; D006680:HLA Antigens; D006681:HLA-D Antigens; D015395:Histocompatibility Antigens Class I