title: Surveillance of alloantibodies after transplantation identifies the risk of chronic rejection.
abstract: The monitoring of the levels of alloantibodies following transplantation might facilitate early diagnosis of chronic rejection (CR), the leading cause of renal allograft failure. Here, we used serial alloantibody surveillance to monitor patients with preoperative positive flow cytometric crossmatch (FCXM). Sixty-nine of 308 renal transplant patients in our center had preoperative positive FCXM. Blood was collected quarterly during the first postoperative year and tested by FCXM and single antigen bead luminometry, more sensitive techniques than complement-dependent cytotoxic crossmatching. Distinct post-transplant profiles emerged and were associated with different clinical outcomes. Two-thirds of patients showed complete elimination of FCXM and solid-phase assay reactions within 1 year, had few adverse events, and a 95% 3-year graft survival. In contrast, the remaining third failed to eliminate flow FCXM or solid-phase reactions directed against HLA class I or II antibodies. The inferior graft survival (67%) with loss in this latter group was primarily due to CR. Thus, systematic assessment of longitudinal changes in alloantibody levels, either by FCXM or solid-phase assay, can help identify patients at greater risk of developing CR.
authors.affiliation: Department of Transplant Surgery, Virginia Commonwealth University Health Systems, Richmond, Virginia 23219, USA. pkimball@gems.vcu.edu
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Kimball
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Baker
authors.forename: Mary B
authors.initials: MB
authors.lastname: Wagner
authors.forename: Anne
authors.initials: A
authors.lastname: King
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000209:etiology*; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012306:Risk; D014019:Tissue Donors
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies