Anti-HLA antibodies posttransplantation in children: do we know what it means?
OBJECTIVE
Anti-HLA antibodies posttransplantation are associated with the appearance of acute and chronic rejection. The goal of this study was to determine the association between the presence of anti-HLA antibodies posttransplantation in children and the clinical outcome.


METHODS
We studied the presence and the level of class I and II anti-HLA antibodies by microbead technology (Luminex) in 32 children after kidney transplantation; 87% underwent a first transplantation. Their mean age was 13.9 +/- 2.52 years. When anti-HLA was positive, 60% of children showed an increase in creatinine within the previous 3 months. The statistical analysis was performed with the SPSS 9.0 program.


RESULTS
Only 4/32 children displayed class I anti-HLA antibodies at low levels (5-7.2) and 43% class II anti-HLA antibodies (level: 5-308). We did not observe an association between the presence of antibodies and age, sex, type of donor, immunosuppression, hypertension, proteinuria, time from transplantation, or reason to evaluate antibodies; 37.5% showed good graft function. The presence of anti-HLA antibodies posttransplantation was associated with retransplantations and with the percentage of antibodies by panel-reactive antibodies. There was trend towards an association with a previous acute rejection episode (P = .072); 62.5% of children with C4d-positive biopsies displayed anti-HLA antibodies vs 20% of those who were C4d-negative (P = .088). Graft survival was 100%.


CONCLUSIONS
The presence of anti-HLA antibodies posttransplantation was influenced by pretransplantation factors-previous level of anti-HLA antibodies, retransplantation, DR matching- and also by posttransplantation factors, such as the occurrence of an acute rejection episode.
García Meseguer
C
C
Pediatric Nephrology Service, La Paz University Hospital, Madrid, Spain. cgarcia.hulp@salud.madrid.org
Hualde
J
J
Alonso
A
A
Espinosa
L
L
Romo
E
E
Paz
E
E
Pérez Fernandez
E
E
D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood*; D000077552:Basiliximab; D002648:Child; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006681:HLA-D Antigens / Q000276:immunology; D015395:Histocompatibility Antigens Class I / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D012086:Reoperation / Q000706:statistics & numerical data; D016559:Tacrolimus / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D001323:Autoantibodies; D006680:HLA Antigens; D006681:HLA-D Antigens; D015395:Histocompatibility Antigens Class I; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D009173:Mycophenolic Acid; D016559:Tacrolimus