title: Anti-human leukocyte antigen immunization after early allograft nephrectomy.
abstract: BACKGROUND
  The occurrence of de novo anti-human leukocyte antigen (HLA) antibodies and donor-specific antibodies (DSAs) after early graft loss is not well known. The aims of this single-center study were to evaluate the incidence of de novo DSAs and non-DSA anti-HLA antibodies after allograft nephrectomy for early graft loss and to seek the predictive factors for the development of DSAs.
  
  
  METHODS
  Thirty-two patients, who experienced an early graft loss (<3 months after transplantation) and required an allograft nephrectomy, and who were considered for retransplantation, were included in the study. Anti-HLA antibodies were assessed, using the Luminex assay, before transplantation, on day 15 and at months 1, 3, 6, and 9 after the nephrectomy, and then every 3 to 6 months until the last follow-up.
  
  
  RESULTS
  The median time between transplantation and allograft nephrectomy was 2.5 (0-81) days. The median follow-up was 335 (30-1441) days. At month 9, postallograft nephrectomy, the incidence of DSAs was 56.6% (17/30). Anti-HLA class I and class II DSAs were detected, respectively, in 33.3% (10/30) and 30% (9/30) of patients. The incidence of de novo non-DSA anti-HLA antibodies was 64% (19/30): of these, 83.3% reacted to the donors' epitopes. Induction therapy (type and dose) and the time between transplantation and allograft nephrectomy did not influence the incidence of DSAs. No independent predictive factor for the development of DSAs was identified.
  
  
  CONCLUSIONS
  Even after a short transplantation period, DSAs and non-DSA anti-HLA antibodies may develop in more than 50% of patients whose immunosuppression has been stopped after an allograft nephrectomy.
authors.affiliation: Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Del Bello
authors.forename: Nicolas
authors.initials: N
authors.lastname: Congy
authors.forename: Federico
authors.initials: F
authors.lastname: Sallusto
authors.forename: Isabelle
authors.initials: I
authors.lastname: Cardeau-Desangles
authors.forename: Marylise
authors.initials: M
authors.lastname: Fort
authors.forename: Laure
authors.initials: L
authors.lastname: Esposito
authors.forename: Joelle
authors.initials: J
authors.lastname: Guitard
authors.forename: Olivier
authors.initials: O
authors.lastname: Cointault
authors.forename: Laurence
authors.initials: L
authors.lastname: Lavayssière
authors.forename: Marie Béatrice
authors.initials: MB
authors.lastname: Nogier
authors.forename: Xavier
authors.initials: X
authors.lastname: Game
authors.forename: Antoine
authors.initials: A
authors.lastname: Blancher
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
mesh_terms: D000906:Antibodies / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007114:Immunization / Q000379:methods*; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D013997:Time Factors; D014184:Transplantation, Homologous
chemical_list: D000906:Antibodies; D006680:HLA Antigens