title: Comprehensive assessment of sensitizing events and anti-HLA antibody development in women awaiting kidney transplantation.
abstract: Alloimmunization remains a critical factor which affects the success of kidney transplantation. Patients awaiting solid organ transplantation may develop anti-HLA antibodies after pregnancies, transfusions and previous events of transplantations.
  
  
  
  We evaluated the effects of different sensitizing events on the anti-HLA antibody production and the potential role of patient HLA alleles in the context of antibody development in both the overall and pregnancy sensitized groups.
  
  
  
  We retrospectively stratified 411 women on waiting list for kidney transplantation by route of sensitization. The presence of anti-HLA antibodies was evaluated by Solid Phase Assay and HLA typing was performed by serological and molecular methods.
  
  
  
  In our study population, 54% of women had anti-HLA antibodies. We found that the 51.6% of women with pregnancy only, 44% of women with transfusion only and 100% of women with a history of transplantation only developed anti-HLA antibodies. Pregnancy only resulted significantly associated with all anti-HLA antibody development such as anti-A, -B, -C, -DR, -DP as well as anti-DQB and -DQA antibodies. We investigated the influence of patient HLA alleles on the antibody development in the overall study population. Patients expressing HLA A*32 (p=0.024, OR=0.42), B*14 (p=0.035, OR=0.44), HLA-B*44 (p=0.026, OR=0.51) and DRB1*01 (p=0.029, OR=0.55) alleles produced anti-HLA antibodies less frequently compared to subjects with other alleles. In the pregnancy only group, B*14 (p=0.010, OR=0.12) and B*51 (p=0.005, OR=0.24) alleles were associated with a low risk of anti-HLA antibody development, while A*11 (p=0.033, OR=3.56) and DRB1*04 (p=0.022, OR=3.03) alleles seem to represent a higher risk.
  
  
  
  Pregnancy still remains a strong sensitizing event in women awaiting kidney transplantation. The anti-HLA antibody development in pregnancy appears to be associated with the expression of particular HLA alleles.
authors.affiliation: U.O.C. Division of Immunohematology, Transfusion Medicine and Transplant Immunology (SIMT), Regional Reference Laboratory of Transplant Immunology (LIT), Department of Internal Medicine and Specialistics, Azienda Ospedaliera Universitaria (AOU), Second University of Naples, Piazza L. Miraglia 2, 80138 Naples, Italy. Electronic address: antonietta.picascia@policliniconapoli.it.
authors.forename: Antonietta
authors.initials: A
authors.lastname: Picascia
authors.affiliation: U.O.C. Division of Immunohematology, Transfusion Medicine and Transplant Immunology (SIMT), Regional Reference Laboratory of Transplant Immunology (LIT), Department of Internal Medicine and Specialistics, Azienda Ospedaliera Universitaria (AOU), Second University of Naples, Piazza L. Miraglia 2, 80138 Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Grimaldi
authors.affiliation: U.O.C. Division of Immunohematology, Transfusion Medicine and Transplant Immunology (SIMT), Regional Reference Laboratory of Transplant Immunology (LIT), Department of Internal Medicine and Specialistics, Azienda Ospedaliera Universitaria (AOU), Second University of Naples, Piazza L. Miraglia 2, 80138 Naples, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Sabia
authors.affiliation: U.O.C. Division of Immunohematology, Transfusion Medicine and Transplant Immunology (SIMT), Regional Reference Laboratory of Transplant Immunology (LIT), Department of Internal Medicine and Specialistics, Azienda Ospedaliera Universitaria (AOU), Second University of Naples, Piazza L. Miraglia 2, 80138 Naples, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Napoli
mesh_terms: D000328:Adult; D000483:Alleles; D005260:Female; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D056724:Immunity, Humoral; D007114:Immunization; D007163:Immunosorbent Techniques; D007518:Isoantibodies / Q000097:blood; D016030:Kidney Transplantation; D008875:Middle Aged; D008991:Monitoring, Physiologic; D057089:Pathology, Molecular; D011110:Polymorphism, Genetic; D011247:Pregnancy / Q000276:immunology*; D066027:Transplant Recipients; D014850:Waiting Lists
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies
keywords: Anti-HLA antibodies; Kidney transplantation; Pregnancy; Sensitizing events; Transfusion