Clinical relevance of human leukocyte antigen antibodies in kidney transplantation from deceased donors: the North Italy Transplant program approach.
At the North Italy Transplant Program (NITp) Reference Center, which is responsible for pre- and posttransplant immunological evaluation and organ allocation, the sera of patients who enter the kidney waiting list are analyzed with complement dependent cytotoxicity (CDC) and a microbead array technique (Luminex). At present, the NITp waiting list includes 2543 patients. The rate of patients with a percentage panel-reactive antibody (PRA) > or =30 with CDC is about 8%; among them, 1% exhibits a %PRA > or =85. Furthermore, 14% of patients have antibodies detectable only with Luminex. The overall 5-year graft survival in the period 1997-2008 is 85%, whereas that of individuals with a CDC %PRA > or =30 is 80.1% (p = 0.0355). A retrospective analysis on the effect of Luminex-detected anti-human leukocyte antigen (HLA) antibodies has suggested that there is a posttransplant immunological response in Luminex-positive patients that can slowly produce kidney damage. Here we present the NITp current policy for the screening and identification of anti-HLA antibodies in relation to kidney allocation algorithm and the authors' view on some aspects of discussion.
Poli
Francesca
F
Organ and Tissue Transplantation Immunology, Fondazione Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena, IRCCS, Milan, Italy. france.poli@policlinico.mi.it
Cardillo
Massimo
M
Scalamogna
Mario
M
D002102:Cadaver; D003165:Complement System Proteins / Q000276:immunology / Q000378:metabolism; D003602:Cytotoxicity, Immunologic; D003888:Desensitization, Immunologic; D006084:Graft Rejection / Q000175:diagnosis* / Q000276:immunology* / Q000517:prevention & control; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007163:Immunosorbent Techniques; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D007558:Italy; D016030:Kidney Transplantation; D008863:Microspheres; D008991:Monitoring, Physiologic; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D019172:Transplantation Conditioning; D014850:Waiting Lists
D006680:HLA Antigens; D007518:Isoantibodies; D003165:Complement System Proteins