title: Frequency and clinical implications of development of donor-specific and non-donor-specific HLA antibodies after kidney transplantation.
abstract: The involvement of immunologic and nonimmunologic events in long-term kidney allograft failure is difficult to assess. The development of HLA antibodies after transplantation is the witness of ongoing reactivity against the transplant, and several studies have suggested that the presence of HLA antibodies correlates with poor graft survival. However, they have not discriminated between donor-specific (DS) and non-specific (NDS) antibodies. A total of 1229 recipients of a kidney graft, transplanted between 1972 and 2002, who had over a 5-yr period a prospective annual screening for HLA antibodies with a combination of ELISA, complement-dependent cytotoxicity, and flow cytometry tests were investigated; in 543 of them, the screening was complete from transplantation to the fifth year postgrafting. Correlations were established between the presence and the specificity of the antibodies and clinical parameters. A total of 5.5% of the patients had DS, 11.3% had NDS, and 83% had no HLA antibodies after transplantation. NDS antibodies appeared earlier (1 to 5 yr posttransplantation) than DS antibodies (5 to 10 yr). In multivariate analysis, HLA-DR matching, pretransplantation immunization, and acute rejection were significantly associated with the development of both DS and NDS antibodies and also of DS versus NDS antibodies. The presence of either DS or NDS antibodies significantly correlated with lower graft survival, poor transplant function, and proteinuria. Screening of HLA antibodies posttransplantation could be a good tool for the follow-up of patients who receive a kidney transplant and allow immunosuppression to be tailored.
authors: Department of Nephrology and Clinical Immunology, Hôtel-Dieu, CHU de Nantes, Nantes Cédex, France.
authors: Maryvonne
authors: M
authors: Hourmant
authors: Anne
authors: A
authors: Cesbron-Gautier
authors: Paul I
authors: PI
authors: Terasaki
authors: Kazuo
authors: K
authors: Mizutani
authors: Anne
authors: A
authors: Moreau
authors: Aurélie
authors: A
authors: Meurette
authors: Jacques
authors: J
authors: Dantal
authors: Magali
authors: M
authors: Giral
authors: Gilles
authors: G
authors: Blancho
authors: Diego
authors: D
authors: Cantarovich
authors: Georges
authors: G
authors: Karam
authors: Gilles
authors: G
authors: Follea
authors: Jean-Paul
authors: JP
authors: Soulillou
authors: Jean-Denis
authors: JD
authors: Bignon
mesh_terms: D000328:Adult; D000918:Antibody Specificity; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / 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
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies