Proinflammatory events are associated with significant increases in breadth and strength of HLA-specific antibody.
Identification of factors responsible for an increase in the breadth or strength of HLA-specific antibody (HSA) is critical to the continued successful management and transplantation of sensitized patients. A retrospective review of our HLA registry identified 107 patients with known HSA and sufficient information in their electronic patient record to determine the presence or absence of a proinflammatory event. The patients were stratified according to transplant status [sensitized and on the transplant waitlist (n = 65); immunosuppressed recipients of a positive crossmatch (+XM) transplant (n = 42)]. Eighty-three percent of waitlist candidates and 55% of sensitized kidney transplant recipients with a documented proinflammatory event had an associated increase in HSA. Interestingly, among patients with a culture-proven infection, 97% of the waitlist patients and 54.8% of +XM recipients had an associated rise in HSA. Overall, proinflammatory events were associated with a greater increase among waitlist patients than +XM recipients, 5.3-fold [IRR 5.25, (95% CI 4.03-6.85), p < 0.001] versus 2.5-fold [IRR 2.54, (95% CI 1.64-3.95), p < 0.001] increase in HSA. Therefore, sensitized patients known to have an infection or undergoing surgery should be monitored for expansion of HSA.
Locke
J E
JE
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. jlocke3@jhmi.edu
Zachary
A A
AA
Warren
D S
DS
Segev
D L
DL
Houp
J A
JA
Montgomery
R A
RA
Leffell
M S
MS
D000368:Aged; D000906:Antibodies / Q000737:chemistry*; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D006680:HLA Antigens / Q000737:chemistry*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007239:Infections / Q000209:etiology; D007249:Inflammation; D016030:Kidney Transplantation / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications; D012042:Registries; D012189:Retrospective Studies; D014850:Waiting Lists
D000906:Antibodies; D006680:HLA Antigens; D007166:Immunosuppressive Agents