Screening for de novo anti-human leukocyte antigen antibodies in nonsensitized kidney transplant recipients does not predict acute rejection.
BACKGROUND
The purpose of this study was to determine whether screening for anti-human leukocyte antigen (HLA) antibodies (Abs) could predict development of acute rejection (AR) before clinical evidence of kidney allograft dysfunction in nonsensitized recipients.


METHODS
Eighty-four non-HLA identical kidney transplant recipients were prospectively tested for anti-HLA Abs (FlowPRA analysis and anti-HLA Ab specificity determination) at 0, 10, 20, 30, 60, 90, 180 and 365 posttransplantation, and at the time of clinical suspicion of AR. Allograft biopsies were performed at the time of engraftment, 3 and 12 months posttransplantation, when patients developed new anti-HLA Abs, or when clinically indicated.


RESULTS
Among the 70 patients without preformed anti-HLA Abs, 11 developed de novo anti-HLA Abs (8 donor-specific Abs) at a median of 30 days (q1-q3=10-180 days) after transplantation. Patients with de novo anti-HLA Abs had a shorter time to AR than patients without de novo anti-HLA Abs, P=0.06. However, in all cases, de novo anti-HLA Abs developed concomitantly or after a clinically evident AR.


CONCLUSIONS
Although de novo anti-HLA Abs were associated with AR, routine screening for anti-HLA Abs was not useful in identifying patients at risk for AR before clinical evidence of allograft dysfunction.
Gill
John S
JS
Division of Nephrology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada. jgill@providencehealth.bc.ca
Landsberg
David
D
Johnston
Olwyn
O
Shapiro
R Jean
RJ
Magil
Alex B
AB
Wu
Vivian
V
Tinckam
Kathryn
K
Keown
Paul
P
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood; D000077552:Basiliximab; D016572:Cyclosporine / Q000627:therapeutic use; D003602:Cytotoxicity, Immunologic; D005434:Flow Cytometry / Q000379:methods; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D006681:HLA-D Antigens / Q000276:immunology; D015395:Histocompatibility Antigens Class I / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D015996:Survival Rate; D016559:Tacrolimus / Q000627:therapeutic use; D014184:Transplantation, Homologous / Q000276:immunology
D000911:Antibodies, Monoclonal; D001323:Autoantibodies; D006680:HLA Antigens; D006681:HLA-D Antigens; D015395:Histocompatibility Antigens Class I; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D011993:Recombinant Fusion Proteins; D016572:Cyclosporine; D000077552:Basiliximab; D009173:Mycophenolic Acid; D016559:Tacrolimus