Rises and falls in donor-specific and third-party HLA antibody levels after antibody incompatible transplantation.
BACKGROUND
After human leukocyte antigen (HLA) antibody-incompatible transplantation, donor specific and third party HLA antibodies may be found, and their levels fall in a donor-specific manner during the first month. However, these changes have not been previously described in detail.


METHODS
Donor-specific HLA antibody (DSA) and third-party HLA antibody (TPA) levels were measured using the microbead method in 44 presensitized patients who had renal transplantation.


RESULTS
DSA+TPA fell in the first 4 days after transplantation, and greater falls in DSA indicated absorption by the graft. This occurred for class I (57.8% fall compared with 20.2% for TPA, P<0.0005), HLA DR (63.0% vs. 24.3%, P<0.0004), and for HLA DP/DQ/DRB3-4 (34% vs. 17.5%, P=0.014). Peak DSA levels occurred at a mean of 13 days posttransplant, and they were higher than pretreatment in 25 (57%) patients and lower in 19 (43%) patients (P=ns). The risk of rejection was associated with peak DSA levels; 15 of 25 (60%) patients with DSA at median fluorescence intensity (MFI) more than 7000U experienced rejection, compared with 4 of 7 (57%) patients with peak DSA MFI 2000 to 7000U, and 2 of 12 (17%) patients with peak DSA MFI less than 2000U (P<0.02). DSA levels subsequently fell in a donor specific manner compared to TPA.


CONCLUSIONS
DSA levels may change markedly in the first month after antibody incompatible transplantation, and the risk of rejection was associated with higher pretreatment and peak levels.
Higgins
Rob
R
Transplant Unit, University Hospitals Coventry and Warwickshire, Coventry, West Midlands, United Kingdom. Robert.Higgins@uhcw.nhs.uk
Lowe
David
D
Hathaway
Mark
M
Lam
For
F
Kashi
Habib
H
Tan
Lam Chin
LC
Imray
Chris
C
Fletcher
Simon
S
Chen
Klaus
K
Krishnan
Nithya
N
Hamer
Rizwan
R
Zehnder
Daniel
D
Briggs
David
D
D001787:Blood Group Incompatibility / Q000276:immunology*; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D006684:HLA-DR Antigens / Q000276:immunology; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use
D006680:HLA Antigens; D006684:HLA-DR Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus