title: Anti-HLA sensitization after kidney allograft nephrectomy: changes one year post-surgery and beneficial effect of intravenous immunoglobulin.
abstract: The analysis of anti-HLA sensitization at the time of and following allograft nephrectomy may help clinicians to define better both the indications for nephrectomy and preventive therapeutic strategies. We carried out a retrospective analysis of anti-HLA antibodies in 63 clinically indicated nephrectomies (baseline and three and 12 months after) according to the time elapsed since transplantation (six months) and clinical background. An intervention study included 10 patients without donor-specific antibodies (DSA) at the time of nephrectomy treated with high-dose intravenous immunoglobulin (IVIG) (1.5 g/kg). Early nephrectomies were performed in 15 patients (24%). Among the late nephrectomies, 14 patients (22%) were asymptomatic and 34 (54%) had graft intolerance syndrome (GIS). At baseline, anti-HLA sensitization was significantly lower in the early and late asymptomatic groups than in the GIS group, but increased considerably within the three months following surgery. In the group of 10 patients treated with IVIG, only the number of class I non-DSA increased in the three months after surgery, whereas in the control group (N = 13), all anti-HLA variables increased significantly. All patients undergoing a clinically indicated allograft nephrectomy become highly sensitized within the 12 months after surgery. In patients without DSA before nephrectomy, high doses of IVIG may prevent anti-HLA sensitization.
authors.affiliation: Nephrology and Renal Transplantation and CIC-BT 504 Department, Henri Mondor Hospital, APHP, Créteil, France.|INSERM U955, Paris Est University, Créteil, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Matignon
authors.affiliation: Nephrology and Renal Transplantation and CIC-BT 504 Department, Henri Mondor Hospital, APHP, Créteil, France.|INSERM U955, Paris Est University, Créteil, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Leibler
authors.affiliation: Nephrology & Public Health Department, CHU Nice, Nice, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Moranne
authors.affiliation: Urology Department, Henri Mondor Hospital, APHP, Paris Est University, Créteil, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.affiliation: Histocompatibility and Immunology Department, Saint Louis Hospital, AP-HP, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Charron
authors.affiliation: Nephrology and Renal Transplantation and CIC-BT 504 Department, Henri Mondor Hospital, APHP, Créteil, France.|INSERM U955, Paris Est University, Créteil, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lang
authors.affiliation: Agence de la biomédecine, Saint Denis, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Jacquelinet
authors.affiliation: Histocompatibility and Immunology Department, Saint Louis Hospital, AP-HP, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Suberbielle
authors.affiliation: Nephrology and Renal Transplantation and CIC-BT 504 Department, Henri Mondor Hospital, APHP, Créteil, France.|INSERM U955, Paris Est University, Créteil, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Grimbert
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007518:Isoantibodies; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000517:prevention & control*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies
keywords: allograft nephrectomy; anti-HLA sensitization; preventive strategies