title: Mothers without HLA antibodies before transplantation have a low risk of alloimmunization post-transplantation.
abstract: Human leukocyte antigen antibodies (HLA Abs) are associated with poor renal graft outcome. We selected 134 first kidney transplant recipients without HLA Ab (LABScreen® Luminex) before transplantation despite previous allogeneic exposure whether through blood transfusion (BT) and/or pregnancy (PR). We screened these patients for HLA Ab post-transplantation (yearly) and determined the risk of HLA Ab and donor-specific antibody (DSA) appearance according to BT/PR in a univariate and a multivariate model. Among the 134 patients (43 males/91 females), 56 were BT+/PR-, 41 BT-/PR+ and 37 BT+/PR+. Median delay between last PR or BT and transplantation were 25.9 years (0.5-47.8) and 8 months (0.8-128.0), respectively. Median number of PR and BT were 2 (1-11) and 3 units (1-28), respectively. After transplantation (median follow-up: 47.5 months), 13 patients (9.7%) had HLA Ab and 10 DSA, mainly directed against class II HLA (HLA Ab: 10/13, DSA: 9/10). The risk of HLA Ab and DSA appearance was significantly lower in patients with PR before transplantation (P = 0.032 and P = 0.009, respectively). The risk of DSA appearance (hazard ratio = 0.17, P = 0.027) remained significantly lower after adjustment on donor age, acute rejection and number of class I/II HLA mismatches. In conclusion, we show that parous women non-immunized are at low risk of HLA Ab production after transplantation.
authors.affiliation: Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHRU Tours, Tours, France.
authors.forename: P
authors.initials: P
authors.lastname: Gatault
authors.forename: I
authors.initials: I
authors.lastname: Jollet
authors.forename: N
authors.initials: N
authors.lastname: Rabot
authors.forename: M D
authors.initials: MD
authors.lastname: Boulanger
authors.forename: J L
authors.initials: JL
authors.lastname: Taupin
authors.forename: C
authors.initials: C
authors.lastname: Barbet
authors.forename: C
authors.initials: C
authors.lastname: Baron
authors.forename: A
authors.initials: A
authors.lastname: Thierry
authors.forename: J M
authors.initials: JM
authors.lastname: Halimi
authors.forename: Y
authors.initials: Y
authors.lastname: Lebranchu
authors.forename: G
authors.initials: G
authors.lastname: Touchard
authors.forename: M
authors.initials: M
authors.lastname: Büchler
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D005260:Female; D005500:Follow-Up Studies; D006680:HLA Antigens / Q000097:blood / Q000276:immunology*; D000949:Histocompatibility Antigens Class II / Q000097:blood / Q000276:immunology*; D006801:Humans; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology*; D008875:Middle Aged; D008954:Models, Biological; D011247:Pregnancy / Q000276:immunology; D013997:Time Factors; D014184:Transplantation, Homologous
chemical_list: D006680:HLA Antigens; D000949:Histocompatibility Antigens Class II; D007518:Isoantibodies