Cytotoxic antibodies--valuable prognostic factor for long term kidney allograft survival.
BACKGROUND
Since the first attempts of kidney transplant, the inflammation mediated by T lymphocytes was considered one of the most important processes implicated in graft rejection but, multiple acute and chronic graft rejects revealed that the inflammation process is not singular and humoral mechanisms may play a role in the development of chronic vascular rejection.


METHODS
We evaluated 500 Romanian patients registered on the kidney transplant waiting list. We performed anti-HLA class I and class II antibodies screening and identification. Laboratory tests were performed at Centre for Immunogenetics and Virology, Fundeni Clinical Institute, Bucharest, Romania. The methods used are represented by ELISA (GTI Diagnosis, USA) and Luminex (Tepnel, USA) RESULTS: pretransplant evaluation of the subjects illustrates that 145 patients (29%) have been sensitized and 355 patients (71%) have not been sensitized. The most frequent types of anti-HLA antibodies were A2 (13%), B42 (10%), DR7 and DR11 (13%). Post transplant, the most cases with de novo antibodies were observed in the first 6 months post transplantation. High serum levels of Il-2 Receptor, TNF-alpha and neopterin in post transplant sensitized patients were observed following de novo cytotoxic antibodies occurrence.


CONCLUSIONS
post renal transplantation, patients present high risk in developing de novo cytotoxic antibodies, especially those who had HLA mismatch with the donor. These antibodies are predictors for acute graft rejection and for graft failure.
Carol Davila Medical University, Immunology of Transplantation, Fundeni-Centre for Immunogenetics and Virology, Bucharest, Romania.
Ana
A
Moise
Daniela
D
Nedelcu
Adela
A
Toader
Mihaela
M
Sora
Anca
A
Tica
Denisa Elena
DE
Ferastraoaru
Ileana
I
Constantinescu
D000906:Antibodies / Q000097:blood; D000920:Antibody-Dependent Cell Cytotoxicity / Q000276:immunology; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D015234:HLA-A Antigens / Q000276:immunology; D015235:HLA-B Antigens / Q000276:immunology; D006684:HLA-DR Antigens / Q000276:immunology; D015395:Histocompatibility Antigens Class I / Q000276:immunology*; D000949:Histocompatibility Antigens Class II / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D012383:Romania
D000906:Antibodies; D006680:HLA Antigens; D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006684:HLA-DR Antigens; D015395:Histocompatibility Antigens Class I; D000949:Histocompatibility Antigens Class II
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