A significant role for anti-human leukocyte antigen antibodies and antibody-mediated rejection in the biopsy-for-cause population.
The role of anti-human leukocyte antigen (HLA) antibodies and antibody-mediated rejection is well known, but our comprehension and the preventive measures we take seem to be insufficient. One of the major causes of premature renal transplant loss is recepients' immunologic hyperactivity to donors' antigens. Monitoring of humoral alloreactivity gives hope for early diagnosis and adequate therapy. The goal of our analysis was the assessment of the influence of anti-HLA antibodies on the function and survival of transplants. In our study we included 60 consecutive renal transplant recipients who had a renal transplant biopsy-for-cause performed due to insufficiency. Transplant biopsies were performed between the 7th day and 12th year (median, 2 years) after transplantation. Anti-HLA antibodies were present in 20 patients (33%). The patients were divided into 2 groups according the presence of anti-HLA antibodies. In a 12-month observation, 10/20 (50%) patients in the anti-HLA(+) group returned to dialysis in contrast with 7/40 (17.5%; P = .014) in the anti-HLA(-) group. Also, 8/10 (80%) of the anti-HLA(+) patients who lost the transplant had anti-HLA Abs class II and only 2/10 (20%) had anti-HLA Abs class I. Anti-HLA antibodies were specific to a donor (donor-specific antibodies [DSA]) in 8/10 (80%) of the patients who lost the transplant. Anti-HLA antibodies appeared de novo in 50% of patients who lost the transplant. Nonadherence was suspected in 50% of patients. Acute humoral rejection occurred in 1 patient. Also, 8/10 (90%) developed chronic active humoral rejection. Our study revealed that graft loss in the renal transplant biopsy-for-cause population with the presence of anti-HLA Abs during a 12-month observation reached 50%. Nonadherence in these patients was very high and amounted to 50%. Monitoring of renal transplant recipients and individualization of therapy considering humoral activity should prolong renal graft survival.
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland. Electronic address: m.banasik@interia.pl.
M
M
Banasik
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
K
K
Kościelska-Kasprzak
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
M
M
Myszka
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
D
D
Bartoszek
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
M
M
Zabińska
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
M
M
Boratyńska
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
D
D
Kamińska
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
O
O
Mazanowska
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
S
S
Zmonarski
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
M
M
Krajewska
Department of Pathomorphology, Wroclaw Medical University, Wroclaw, Poland.
A
A
Hałoń
Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Wroclaw, Poland.
T
T
Dawiskiba
Institute of Immunology and Experimetal Therapy, Polish Academy of Science, Wroclaw, Poland.
B
B
Nowakowska
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
M
M
Klinger
D000328:Adult; D001323:Autoantibodies / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D015395:Histocompatibility Antigens Class I / Q000276:immunology; D000949:Histocompatibility Antigens Class II / Q000276:immunology; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis
D001323:Autoantibodies; D006680:HLA Antigens; D015395:Histocompatibility Antigens Class I; D000949:Histocompatibility Antigens Class II