The Kinetics of Anti-HLA Antibodies in the First Year after Kidney Transplantation: In Whom and When Should They Be Monitored?

Journal of Transplantation
Maria Cristina Ribeiro de CastroElias David-Neto

Abstract

The impact of the kinetics of the anti-HLA antibodies after KTx on the occurrence of acute rejection as well as the better time-point to monitor anti-HLA Abs after transplantation is not completely defined. This prospective study followed 150 patients over 12 months after transplantation. Serum IgG anti-HLA Abs were detected by single antigen beads after typing donors and recipients for loci A, B, C, DR, and DQ. Before KTx, 89 patients did not present anti-HLA Abs and 2% developed "de novo" Abs during the 1st year, 39 patients were sensitized without DSAs, and 13% developed DSA after surgery; all of them presented ABMR. Sensitized patients presented higher acute rejection rates (36.4% versus 13.5%, p < 0.001), although 60% of the patients did not present ABMR. Patients, in whom DSA-MFI decreased during the first two weeks after surgery, did not develop ABMR. Those who sustained their levels presented a rate of 22% of ABMR. 85% of patients developed ABMR when MFIs increased early after transplantation (which occurred in 30% of the DSA positive patients). In the ABMR group, we observed an iDSA-MFI sharp drop on the fourth day and then an increase between the 7th and 14th POD, which suggests DSA should be monitored at this moment ...Continue Reading

References

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Apr 18, 2012·Nature Reviews. Nephrology·Alexandre LoupyStanley C Jordan
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Sep 27, 2013·The New England Journal of Medicine·Alexandre LoupyXavier Jouven
Jun 1, 2014·Transplantation·Raymond L HeilmanKunam Sudhakar Reddy
Aug 22, 2014·Clinical Transplantation·Patrícia Soares de SouzaMaria Cristina Ribeiro de Castro

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