title: Clinical value of non-HLA antibodies in kidney transplantation: Still an enigma?
abstract: HLA antibodies play a major role in the recipient's immune response against the renal allograft and are an established risk factor for antibody-mediated rejection and subsequent impaired graft survival. Evidence originating from HLA-identical donor-recipient pairs indicates that non-HLA antibodies may play a role as well. Numerous non-HLA antibodies have been identified in renal organ transplantation, directed against a heterogeneous subset of both allo- and autoantigens including MHC Class-I-related chain A (MICA) and Angiotensin II type 1 receptor (AT1R). In this review, we will discuss the mechanisms predisposing to non-HLA antibody formation, the possible synergy with HLA-antibodies in their pathologic potential and the mechanisms involved in allograft damage. Furthermore, an overview of the identified non-HLA antibodies and antigens and their relation with rejection and graft survival will be provided.
authors.affiliation: Department of Nephrology and Hypertension, University Medical Center Utrecht, P.O. Box 85500, Utrecht, 3508, GA Utrecht, The Netherlands. Electronic address: l.a.michielsen@umcutrecht.nl.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Michielsen
authors.affiliation: Department of Nephrology and Hypertension, University Medical Center Utrecht, P.O. Box 85500, Utrecht, 3508, GA Utrecht, The Netherlands.
authors.forename: Arjan D
authors.initials: AD
authors.lastname: van Zuilen
authors.affiliation: Department of Nephrology and Hypertension, University Medical Center Utrecht, P.O. Box 85500, Utrecht, 3508, GA Utrecht, The Netherlands.
authors.forename: Merle M
authors.initials: MM
authors.lastname: Krebber
authors.affiliation: Department of Nephrology and Hypertension, University Medical Center Utrecht, P.O. Box 85500, Utrecht, 3508, GA Utrecht, The Netherlands.
authors.forename: Marianne C
authors.initials: MC
authors.lastname: Verhaar
authors.affiliation: Laboratory of Translational Immunology, University Medical Center Utrecht, P.O. Box 85500, Utrecht, 3508, GA Utrecht, The Netherlands.
authors.forename: Henny G
authors.initials: HG
authors.lastname: Otten
mesh_terms: D000906:Antibodies; D006084:Graft Rejection; D006085:Graft Survival; D006680:HLA Antigens; D006801:Humans; D016030:Kidney Transplantation
chemical_list: D000906:Antibodies; D006680:HLA Antigens