Incidence and impact of anti-HLA-DP antibodies in renal transplantation.
The role of anti-HLA-DP antibodies in renal transplantation is poorly defined. This study describes the impact of donor (donor-specific antibody [DSA]) and non-donor-specific antibodies against HLA-DP antigens in renal transplant patients.



Of 195 consecutive patients transplanted between September 2009 and December 2011, 166 primary kidney recipients and their donors were typed (high-resolution) for DP antigens. Sera taken pre-transplant and at 1, 3, 6, 9, and 12 months, and annually post-transplant were retrospectively tested for anti-DP antibodies using single-antigen beads.



In 81 (49%) patients, anti-DP antibodies were found; 64% (n=52) of patients were positive in the pre-transplant samples and 36% (n=29) were positive exclusively post-transplant. The median time from transplantation to antibody was 20.9 months. Fifty-five percent (n=16) of the de novo anti-DP antibodies were accompanied by another de novo DSA. Anti-DP antibody-positive patients had a higher rate of rejection (compared with anti-DP antibody-negative patients, P=.01). The estimated glomerular filtration rate declined more with anti-DP antibodies (-5.5% vs +26%).



Antibodies against HLA-DP antigens are common. De novo anti-DP antibodies commonly appear after acute rejection and accompany DSA, which makes it difficult to determine whether anti-DP antibodies are the cause or the consequence of graft injury.
Terasaki Foundation Laboratory, Los Angeles, CA, USA.
Mareike
M
Hörmann
Terasaki Foundation Laboratory, Los Angeles, CA, USA.
Georg
G
Dieplinger
Department of Pathology, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
Lorita M
LM
Rebellato
Department of Pathology, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
Kimberly P
KP
Briley
Department of Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
Paul
P
Bolin
Department of Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
Claire
C
Morgan
Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
Carl E
CE
Haisch
Terasaki Foundation Laboratory, Los Angeles, CA, USA. meverly@terasakilab.org.
Matthew J
MJ
Everly
D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology; D006682:HLA-DP Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D015994:Incidence; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D012189:Retrospective Studies; D014019:Tissue Donors
D006682:HLA-DP Antigens; D007518:Isoantibodies
DP antibodies; donor-specific antibodies; human leukocyte antigen; renal transplantation