Higgins, Rob, Hathaway, Mark, Lowe, David, Lam, For, Kashi, Habib, Tan, Lam Chin, Imray, C. (Chris), Fletcher, Simon, Zehnder, Daniel, Chen, Klaus, Krishnan, Nithya, Hamer, Rizwan and Briggs, David. (2007) Blood levels of donor-specific human leukocyte antigen antibodies after renal transplantation : resolution of rejection in the presence of circulating donor-specific antibody. Transplantation, Vol.84 (No.7). pp. 876-884. ISSN 0041-1337

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Abstract

Background. Accommodation to antibody is an important mechanism in successful ABO-incompatible transplantation, but its importance in human leukocyte antigen (HLA) antibody-incompatible transplantation is less clear, as sensitive techniques facilitating daily measurement of donor-specific HLA antibodies (DSAs) have only recently been developed. Methods. We report 24 patients who had HLA antibody-incompatible kidney transplantation (21 living donors, 3 deceased), 21 of whom had pretransplant plasmapheresis. Eight had positive complement-dependent cytotoxic (CDC) crossmatch (XM) pretransplant plasmapheresis, nine had positive flow cytometric (FC) XM, and seven had DSA detectable by microbead analysis only. After transplant, DSA levels were monitored closely with microbead assays. Results. Rejection occurred in five of eight (62.5%) CDC-positive cases, in three of nine (33%) FC-positive cases, and in two of seven (29%) of microbead-only cases at a median of 6.5 days after transplantation. Resolution occurred at a median of 15 days after transplantation, in 8 of 10 cases when the microbead level of DSA had median fluorescence intensity (MFI) > 2000 U, in 6 of 10 when the microbead MFI > 4000 U. In 8 of 10 cases, the microbead MFI at the time of resolution was greater than at the onset. DSA did not always cause clinical rejection. In five cases with a posttransplant DSA peaking at MFI > 2000 U on microbead assay, rejection did not occur. Conclusion. These data suggest that the dominant method of successful transplantation was function of the transplant in the presence of circulating DSA, and they also define the period during which this occurred.

Item Type:	Journal Article
Subjects:	Q Science > QR Microbiology > QR180 Immunology R Medicine > RD Surgery
Divisions:	Faculty of Medicine > Warwick Medical School > Education Development and Research Faculty of Medicine > Warwick Medical School > Metabolic and Vascular Health Faculty of Medicine > Warwick Medical School
Journal or Publication Title:	Transplantation
Publisher:	Lippincott Williams & Wilkins
ISSN:	0041-1337
Date:	15 October 2007
Volume:	Vol.84
Number:	No.7
Number of Pages:	9
Page Range:	pp. 876-884
Identification Number:	10.1097/01.tp.0000284729.39137.6e
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
URI:	http://wrap.warwick.ac.uk/id/eprint/31272

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