Predictive value of HLA antibodies and serum creatinine in chronic rejection: results of a 2-year prospective trial.
In this large collaborative study, 2,231 transplanted patients with functioning kidneys were tested for HLA antibodies, then examined 2 years later for graft survival. Among 478 patients with antibodies, 15.1% failed in 2 years, compared to 6.8% failure in 1,753 patients without antibodies (P=0.00000002). Cytotoxicity testing correlated better with outcome than flow cytometry or ELISA testing on HLA coated beads, possibly because it detected non-HLA antigens. When the patients were further broken down into those with serum creatinine at the time of testing of 0.5-1.9, 4.4% of antibody patients failed at 2 years, compared to 4.3% of patients without antibodies. This 0.1% difference increased among patients with serum creatinine values of 2.0-2.9 to 17.9%, and among those with 3.0-3.9 to 16.3%. We conclude that HLA antibodies posttransplantation is predictive of subsequent graft failure, and its predictive value can be enhanced among patients with higher serum creatinine values.
Terasaki
Paul I
PI
Terasaki Foundation Laboratory, Los Angeles, CA 90064, USA. terasaki@terasakilab.org
Ozawa
Miyuki
M
D000906:Antibodies / Q000097:blood*; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood*; D006084:Graft Rejection / Q000097:blood* / Q000209:etiology*; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011446:Prospective Studies
D000906:Antibodies; D006680:HLA Antigens; D003404:Creatinine