title: Dynamics of anti-human leukocyte antigen antibodies after renal transplantation and their impact on graft outcome.
abstract: The purpose of this study was to sequentially monitor anti-HLA antibodies and correlate the results with antibody-mediated rejection (AMR), graft survival (GS), and graft function (GF). We collected sera from 111 kidney transplant recipients on transplant days 0, 7, 14, 30, 60, 90, 180, and 360 and analyzed PRA levels by ELISA. DSAs were analyzed by single-antigen beads in rejecting kidneys. At pre-transplant, 79.3% of the patients were non-sensitized (PRA = 0%) and 20.7% were sensitized (PRA > 1%). After transplant, patients were grouped by PRA profile: no anti-HLA antibodies pre- or post-transplant (group HLApre-/post-; n = 80); de novo anti-HLA antibodies post-transplant (group HLApre-/post+; n = 8); sensitized pre-transplant/increased PRA post-transplant (group HLApre+/post↑; n = 9); and sensitized pre-transplant/decreased PRA post-transplant (group HLApre+/post↓; n = 14). De novo anti-HLA antibodies were detected at 7-180 d. In sensitized patients, PRA levels changed within the first 30 d post-transplant. Incidence of AMR was higher in HLApre-/post+ and HLApre+/post↑ than in HLApre-/post-, and HLApre+/post↓ (p < 0.001) groups. One-yr death-censored GS was 36% in group HLApre+/post↑, compared with 98%, 88% and 100% in groups HLApre-/post-, HLApre-/post+, and HLApre+/post↓, respectively (p < 0.001). Excluding first-year graft losses, GF and GS were similar among the groups. In conclusion, post-transplant antibody monitoring can identify recipients at higher risk of AMR.
authors.affiliation: Renal Transplantation Service of Urology Division, Hospital das Clínicas de São Paulo, Sao Paulo University, Sao Paulo, Brazil; Nephrology Department, Hospital das Clínicas de São Paulo, Sao Paulo University, Sao Paulo, Brazil.
authors.forename: Patrícia Soares
authors.initials: PS
authors.lastname: de Souza
authors.forename: Elias
authors.initials: E
authors.lastname: David-Neto
authors.forename: Nicolas
authors.initials: N
authors.lastname: Panajotopolous
authors.forename: Fabiana
authors.initials: F
authors.lastname: Agena
authors.forename: Hélcio
authors.initials: H
authors.lastname: Rodrigues
authors.forename: Carla
authors.initials: C
authors.lastname: Ronda
authors.forename: Daísa Ribeiro
authors.initials: DR
authors.lastname: David
authors.forename: Jorge
authors.initials: J
authors.lastname: Kalil
authors.forename: Wiliam Carlos
authors.initials: WC
authors.lastname: Nahas
authors.forename: Maria Cristina Ribeiro
authors.initials: MC
authors.lastname: de Castro
mesh_terms: D000328:Adult; D000906:Antibodies / Q000097:blood*; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006084:Graft Rejection / Q000097:blood*; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D006680:HLA Antigens
keywords: anti-HLA antibodies; antibody-mediated rejection; graft function; graft survival