title: Clinical relevance of anti-HLA antibodies detected by flow-cytometry bead-based assays--single-center experience.
abstract: The purpose of this study was to define the incidence, dynamics, and profiles of anti-human leukocyte antigen antibodies (HLA-Abs) produced after kidney transplantation and their impact on graft outcome. A total of 72 first cadaver donor kidney recipients were prospectively monitored for the development of HLA-Abs using bead-based flow-cytometry assays (One Lambda FlowPRA tests). Sixteen recipients (22.2%) developed HLA-Abs after transplantation (class I, n = 7; class I+II, n = 6; class II, n = 3), in most cases (81.25%) within the first 2 weeks posttransplantation. A strong association between alloantibody presence and delayed graft function (Chi-square = 7.659, p < 0.01), acute rejection (Chi-square = 14.504, p < 0.001), chronic rejection (Chi-square = 12.84, p < 0.001), and graft loss (Chi-square = 20.283, p < 0.001) was found. Patients with higher alloantibody titers experienced acute rejections and even early graft loss, compared with those with lower titers for whom chronic rejections were more common. Immunologic complications occurred in recipients with both donor-specific and cross-reacting groups or non-donor-specific antibodies alone. A positive correlation (Pearson correlation, 0.245; p < 0.05) between HLA class I amino acid triplet incompatibility and alloantibody production was observed, mainly resulting from immunogenic triplotypes. Given the results obtained in this study, an alloantibody testing algorithm has been designed and implemented for routine monitoring and to define optimally the alloantibody reactivity in kidney transplant recipients.
authors.affiliation: Central Laboratory of Clinical Immunology, University Hospital Alexandrovska, Sofia, Bulgaria. mihaylova_ap@abv.bg
authors.forename: Anastassia
authors.initials: A
authors.lastname: Mihaylova
authors.forename: Daniela
authors.initials: D
authors.lastname: Baltadjieva
authors.forename: Petia
authors.initials: P
authors.lastname: Boneva
authors.forename: Milena
authors.initials: M
authors.lastname: Ivanova
authors.forename: Kalina
authors.initials: K
authors.lastname: Penkova
authors.forename: Daniela
authors.initials: D
authors.lastname: Marinova
authors.forename: Snejina
authors.initials: S
authors.lastname: Mihailova
authors.forename: Emil
authors.initials: E
authors.lastname: Paskalev
authors.forename: Petar
authors.initials: P
authors.lastname: Simeonov
authors.forename: Elissaveta
authors.initials: E
authors.lastname: Naumova
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D005260:Female; D005434:Flow Cytometry; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D015234:HLA-A Antigens / Q000276:immunology; D015235:HLA-B Antigens / Q000276:immunology; D006683:HLA-DQ Antigens / Q000276:immunology; D006684:HLA-DR Antigens / Q000276:immunology; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged
chemical_list: D006680:HLA Antigens; D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006683:HLA-DQ Antigens; D006684:HLA-DR Antigens; D007518:Isoantibodies