title: Kidney transplantation in patients with antibodies against donor HLA class II.
abstract: The immunologic risk associated with donor-specific antibodies (DSA) against Class II human leukocyte antigens (HLA) in kidney transplant (KTx) recipients is unclear. The aim of this study was to determine the outcome of KTx when DSA was detected only against HLA Class II. To isolate the impact of anti-Class II DSA, we retrospectively analyzed 12 KTx recipients who at baseline had a positive B-cell flow cytometric crossmatch (FXM) and a negative T-cell FXM. Using alloantibody specification analysis, 58.3% (7/12) had DSA against donor Class II and 41.7% had no demonstrable DSA. Biopsy-proven AMR occurred in 57% (4/7) in the Class II(+) group and 0% in the Class II(-) group (p > 0.05). Peritubular capillaries stained positive for C4d in 86% (6/7) of the Class II(+) patients and in 40% (2/5) of the Class II(-) patients (p > 0.05). One patient in the Class II(+) group lost their graft at 3 months to accelerated transplant glomerulopathy, while all other grafts were functioning 3-37 months posttransplant despite the persistence of anti-Class II DSA. We conclude that KTx recipients with clearly defined anti-Class II DSA are at risk for humoral rejection suggesting that desensitization and/or close posttransplant monitoring may be needed to prevent AMR.
authors.affiliation: Division of Transplantation Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: H S
authors.initials: HS
authors.lastname: Pollinger
authors.forename: M D
authors.initials: MD
authors.lastname: Stegall
authors.forename: J M
authors.initials: JM
authors.lastname: Gloor
authors.forename: S B
authors.initials: SB
authors.lastname: Moore
authors.forename: S R
authors.initials: SR
authors.lastname: Degoey
authors.forename: N A
authors.initials: NA
authors.lastname: Ploeger
authors.forename: W D
authors.initials: WD
authors.lastname: Park
authors.forename: H S
authors.initials: HS
authors.lastname: Pollinger
authors.forename: M D
authors.initials: MD
authors.lastname: Stegall
authors.forename: J M
authors.initials: JM
authors.lastname: Gloor
authors.forename: S B
authors.initials: SB
authors.lastname: Moore
authors.forename: S R
authors.initials: SR
authors.lastname: Degoey
authors.forename: N A
authors.initials: NA
authors.lastname: Ploeger
authors.forename: W D
authors.initials: WD
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D001402:B-Lymphocytes / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology; D006681:HLA-D Antigens / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood*; D007674:Kidney Diseases / Q000145:classification / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D006681:HLA-D Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies