Long-term Follow-up of Non-HLA and Anti-HLA Antibodies: Incidence and Importance in Renal Transplantation

• Published in: Transplantation proceedings Vol. 45; no. 4; pp. 1462 - 1465
• Main Authors: Banasik, M, Boratyńska, M, Kościelska-Kasprzak, K, Mazanowska, O, Bartoszek, D, Żabińska, M, Myszka, M, Nowakowska, B, Hałoń, A, Szyber, P, Patrzałek, D, Klinger, M
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2013
• Subjects: Adult; Autoantibodies - blood; Female; Follow-Up Studies; HLA Antigens - immunology; Humans; Incidence; Kidney Transplantation; Male; Middle Aged; Surgery
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2012.11.025

Abstract Background Detection of antibody-mediated injury is becoming increasingly important in post-transplant patient care. The role of donor-specific anti-human leukocyte antigen (HLA) antibodies in kidney transplant damage is known, whereas the significance of non-HLA antibodies remains an unresolved concern. The aim of the study was to determine the presence and influence on renal function of non-HLA and anti-HLA antibodies in stable patients at 5 years after kidney transplantation. Methods We evaluated the antibodies in 35 consecutive patients with stable renal function at 5 years after transplantation. Results Pretransplant screening for donor-specific antibodies by CDC cross-matches was negative in all patients. Anti-endothelial cell antibodies (AECA), anti-angiotensin II type 1 receptor antibodies (anti-AT1 R), and anti-endothelin receptor antibodies (anti-ETAR) were assayed as non-HLA antibodies. Non-HLA antibodies were observed in 12 (34%) patients, including AECA ( n = 5; 14%), anti- AT1 R ( n = 6; 17%), anti-ETAR ( n = 4; 11%), and both anti-AT1 R and anti-ETAR ( n = 3). Among 13 (37%) patients with anti-HLA antibodies, 7 also had both non-HLA antibodies: AECA ( n = 1), anti-AT1 R ( n = 3), and anti-ETAR ( n = 3). The antibody-negative group ( n = 13) showed significantly better renal function than the antibody-positive group (non-HLA and/or anti-HLA; n = 22). Biopsy-proven acute rejection had occurred in 2 of 13 (15%) antibody-negative versus 8 of 22 (36%) antibody-positive patients. These preliminary data revealed an high prevalence of autoantibody and alloantibody production among stable patients at 5 years after kidney transplantation. Conclusion Simultaneous production of these antibodies and their association with reduced renal function suggests that active humoral immune responses are poorly controlled by immunosuppression.