[Post-transplantation anti-HLA antibodies: which relevance?].
Anti-HLA antibodies formed de novo post-transplantation are involved in the development of acute humoral rejection also known as antibody-mediated rejection. This form of rejection is characterized by histological lesions, a positive C4d-staining of peritubular capillaries and anti-donor antibodies. The presence of anti-HLA antibodies indicates a poor prognosis as it is associated with a highly significant increase of graft loss risk, which might depend on antibody concentration. To prevent acute humoral rejection, antibodies must be systematically detected 3 months after transplantation with sensitive methods using recombinant HLA antigens that allow detecting anti-HLA antibodies by ELISA, flow cytometric panel-reactive antibodies test or immunobead flow cytometric assay, the intensity of fluorescence determining the concentration of anti-HLA antibodies. In case of acute graft dysfunction, antibody-mediated rejection must be treated by a combination of immunosuppressive drugs, antibodies, intra-venous immunoglobulins and/or plasmaphereses.
Glotz
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Service de Néphrologie, Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 PARIS cedex 10, France. denis.glotz@sls.ap-hop-paris.fr
D000208:Acute Disease; D000906:Antibodies / Q000097:blood*; D000917:Antibody Formation; D006084:Graft Rejection / Q000097:blood* / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*
D000906:Antibodies; D006680:HLA Antigens