Distribution of donor-specific antibodies in the cortex and the medulla of renal transplants with chronic allograft nephropathy.
BACKGROUND
Emerging data suggest that donor-specific HLA antibodies should be more frequently found onto the transplant itself than in the bloodstream. It is now possible to detect such antibodies in kidney transplant needle biopsy samples by flow cytometry. In order to know if the detection of antibodies into such blind biopsy samples depends of the site of the biopsy, we have studied the distribution of antibodies in both the cortex and medulla of 12 transplants removed after graft loss due to chronic allograft nephropathy, and in 10 controls.


METHODS
Donor-specific HLA antibodies were extracted from the cortex and the medulla of each removed transplant by an acid elution and characterized by Luminex assays.


RESULTS
They were found in 58.3% of transplants with chronic allograft nephropathy and never in other kidney samples. The same antibodies were found in the bloodstream at the time of transplantectomy in only 16.6% of the recipients. The distribution between the cortex and medulla was concordant in 75% of cases. However, we observed 2 discrepancies: one in favor of the cortex and one in favor of the medulla. A majority (5/7) transplants with CAN and intra-graft donor-specific antibodies had also C4d deposits along peritubular capillaries.


CONCLUSIONS
Testing for donor-specific HLA antibodies in kidney transplant needle biopsies can be of value provided the biopsy includes both the cortex and the medulla.
Bocrie
Olivier
O
UPRES EA 563, Faculty of Medicine, University Hospital, Dijon, France.
Hussein Aly
Aymen Ahmed
AA
Guignier
Fredy
F
Funes de la Vega
Mathilde
M
Rifle
Gérard
G
Mousson
Christiane
C
Martin
Laurent
L
D000906:Antibodies / Q000032:analysis*; D044963:Biopsy, Fine-Needle; D002908:Chronic Disease; D006084:Graft Rejection / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007158:Immunologic Techniques; D007674:Kidney Diseases / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology*; D014019:Tissue Donors; D014184:Transplantation, Homologous
D000906:Antibodies; D006680:HLA Antigens