Association Between HLA Antibodies and Different Sensitization Events in Renal Transplant Candidates.
BACKGROUND
Human leukocyte antigen (HLA) allo-immunization is caused by various events such as blood transfusions, pregnancies, or organ transplantations, which can lead to sensitization. In this retrospective study, we evaluated different sensitization models and their effects on panel-reactive antibody (PRA) profiles of renal transplantation candidates.


METHODS
Anti-HLA class I/II antibody screening tests were performed in 906 renal transplantation candidates with the use of a microbead-based assay (Luminex).


RESULTS
Two hundred ninety-seven (32.8%) of the patients were determined as positive in terms of PRA, and 609 (67.2%) were negative. Sensitized and non-sensitized patients were compared separately in terms of each sensitization type. The anti-HLA class I, II, and I+II positivity rates in patients sensitized only by blood transfusion were 13.1%, 6.3%, and 14.1%, the rates with pregnancy sensitization were 35.5%, 29%, and 45.2%, and rates with previous transplantation sensitization were 15.6%, 34.4%, and 38.9%, respectively. Prevalence of PRA positivity was significantly higher in patients with previous pregnancy than with transplantation and transfusion (odds ratio, 1.003; 95% confidence interval, 0.441-2.281; P = .031). The risk of developing HLA class I antibodies was higher in pregnancies (P < .001), and the risk of developing anti-HLA class II antibodies was higher in patients who had undergone a previous transplantation (P < .001). The rate of developing HLA-B antibodies in patients sensitized by pregnancy were significantly higher compared with sensitization after transfusion (P = .015), as was the rate of developing HLA-DQ antibodies in patients sensitized by previous transplantation compared with sensitization through pregnancy (P = .042).


CONCLUSIONS
In patients who are waiting for kidney transplantation, sensitization by pregnancy and transplantation have a significant impact on development of HLA class I and class II antibodies.
Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey. Electronic address: sebahatakgul@gmail.com.
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Akgul
Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Ciftci
Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Temurhan
Department of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Caliskan
Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Bayraktar
Department of Urology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Tefik
Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Kaya
Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Canitez
Department of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Demir
Department of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Yazici
Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Bakkaloglu
Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Aydin
Department of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Turkmen
Department of Urology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Nane
Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Aydin
Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Oguz
D000328:Adult; D001323:Autoantibodies; D001803:Blood Transfusion; D005260:Female; D015395:Histocompatibility Antigens Class I / Q000276:immunology*; D000949:Histocompatibility Antigens Class II / Q000276:immunology*; D006801:Humans; D007114:Immunization; D007159:Immunologic Tests; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011247:Pregnancy / Q000276:immunology*; D012189:Retrospective Studies; D014181:Transplantation Immunology
D001323:Autoantibodies; D015395:Histocompatibility Antigens Class I; D000949:Histocompatibility Antigens Class II