Detection of donor-specific HLA antibodies before and after removal of a rejected kidney transplant.
Serum analysis of patients considered for retransplantation has a potential limitation that the rejected allograft may absorb HLA antibodies. We have determined how the highly sensitive micro bead-based Luminex antibody-binding assay with single antigens can detect donor-specific HLA antibodies (DSA) in patients before and after surgical removal of a rejected allograft. This analysis was done for 65 allograft nephrectomy (allonx) cases contributed by 16 laboratories worldwide. In the HLA-A,B and -DRB1 mismatch categories the incidence of DSA reactivity pre-allonx and post-allonx was 64% vs 87% (p=0.0033) and 57% vs 86% (p=0.001), respectively. The frequencies of individual reactive antigens were also lower before allonx: for HLA-A,B antigens: 49% vs 75% (p<0.0001) and DRB1 antigens: 48% vs 79% (p=0.0001). On the other hand, no significant differences were seen between the pre-allonx and post-allonx frequencies of DSA to DRB3/4/5 (65% vs 78%, p=0.22) and DQ mismatches (76% vs 87%, p=0.18).


CONCLUSIONS
although the sensitive Luminex antibody assay can detect anti-donor antibodies in the presence of a rejected transplant, it is apparent that the antibody specificity pattern is often incomplete especially against the HLA-A, -B and DR mismatches. This understanding seems relevant to the determination of acceptable mismatches for patients considered for retransplantation.
Marrari
Marilyn
M
Division of Transplant Pathology and Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Thomas E. Starzl Biomedical Science Tower, Room W1552, Pittsburgh, PA 15261, United States.
Duquesnoy
Rene J
RJ
D000917:Antibody Formation / Q000276:immunology; D000939:Epitopes / Q000276:immunology; D006084:Graft Rejection / Q000097:blood / Q000453:epidemiology / Q000276:immunology* / Q000628:therapy; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology*; D006648:Histocompatibility / Q000235:genetics; D006650:Histocompatibility Testing; D006801:Humans; D015994:Incidence; D007518:Isoantibodies / Q000097:blood* / Q000276:immunology; D016030:Kidney Transplantation; D008863:Microspheres; D009392:Nephrectomy; D012086:Reoperation
D000939:Epitopes; D006680:HLA Antigens; D007518:Isoantibodies