title: Human leukocyte antigen sensitization after structural cortical allograft implantations.
abstract: The incidence and significance of a donor-specific human leukocyte antigen antibody response to massive fresh-frozen human bone allograft implantation is not established. This study was a prospective, multicenter study of a cohort of consecutive patients who self-randomized themselves into two groups based on their alloantibody response to allograft bone transplant. The study hypothesis was that donor-directed antibodies are an independent risk factor influencing incorporation of massive frozen bone allografts. Pretransplant and posttransplant human leukocyte antigen alloantibody analysis was performed and correlated to determine pre-existing and graft-induced antibodies. The surgical outcomes of the two groups of patients were compared to determine the relationship between alloantibody response and bone graft incorporation. Preliminary results revealed that donor-specific human leukocyte antigen sensitization occurred in 17 of 32 (53%) of previously nonsensitized patients. A survival analysis of time to healing based on human leukocyte antigen status showed no evidence of an association between human leukocyte antigen status and time to healing. Longer followup in additional patients will be required to determine if this sensitization is correlated with an alteration in the time to union or with the quality or type of bone graft incorporation.
  
  
  METHODS
  Therapeutic study, Level II. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Health Sciences, Winston-Salem, NC, USA.
authors.forename: William G
authors.initials: WG
authors.lastname: Ward
authors.forename: Eugene
authors.initials: E
authors.lastname: Heise
authors.forename: Carol
authors.initials: C
authors.lastname: Boles
authors.forename: David
authors.initials: D
authors.lastname: Kiger
authors.forename: Michael
authors.initials: M
authors.lastname: Gautreaux
authors.forename: Julia
authors.initials: J
authors.lastname: Rushing
authors.forename: Beth Paterson
authors.initials: BP
authors.lastname: Smith
authors.forename: Debra
authors.initials: D
authors.lastname: Bullard
mesh_terms: D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000276:immunology*; D016025:Bone Transplantation / Q000276:immunology*; D016009:Chi-Square Distribution; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014181:Transplantation Immunology; D014184:Transplantation, Homologous
chemical_list: D001323:Autoantibodies; D006680:HLA Antigens