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Dynamics of anti‐human leukocyte antigen antibodies after renal transplantation and their impact on graft outcome
Author(s) -
Souza Patrícia Soares,
DavidNeto Elias,
Panajotopolous Nicolas,
Agena Fabiana,
Rodrigues Hélcio,
Ronda Carla,
David Daísa Ribeiro,
Kalil Jorge,
Nahas Wiliam Carlos,
Castro Maria Cristina Ribeiro
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12451
Subject(s) - medicine , human leukocyte antigen , antibody , panel reactive antibody , transplantation , renal transplant , immunology , incidence (geometry) , kidney transplantation , antigen , donor specific antibodies , kidney transplant , gastroenterology , physics , optics
Abstract The purpose of this study was to sequentially monitor anti‐ HLA antibodies and correlate the results with antibody‐mediated rejection ( AMR ), graft survival ( GS ), and graft function ( GF ). We collected sera from 111 kidney transplant recipients on transplant days 0, 7, 14, 30, 60, 90, 180, and 360 and analyzed PRA levels by ELISA . DSA s were analyzed by single‐antigen beads in rejecting kidneys. At pre‐transplant, 79.3% of the patients were non‐sensitized ( PRA = 0%) and 20.7% were sensitized ( PRA > 1%). After transplant, patients were grouped by PRA profile: no anti‐ HLA antibodies pre‐ or post‐transplant (group HLA pre−/post−; n = 80); de novo anti‐ HLA antibodies post‐transplant (group HLA pre−/post+; n = 8); sensitized pre‐transplant/increased PRA post‐transplant (group HLA pre+/post↑; n = 9); and sensitized pre‐transplant/decreased PRA post‐transplant (group HLA pre+/post↓; n = 14). De novo anti‐ HLA antibodies were detected at 7–180 d. In sensitized patients, PRA levels changed within the first 30 d post‐transplant. Incidence of AMR was higher in HLA pre−/post+ and HLA pre+/post↑ than in HLA pre−/post−, and HLA pre+/post↓ (p < 0.001) groups. One‐yr death‐censored GS was 36% in group HLA pre+/post↑, compared with 98%, 88% and 100% in groups HLA pre−/post−, HLA pre−/post+, and HLA pre+/post↓, respectively (p < 0.001). Excluding first‐year graft losses, GF and GS were similar among the groups. In conclusion, post‐transplant antibody monitoring can identify recipients at higher risk of AMR .