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Blood levels of donor-specific human leukocyte antigen antibodies after renal transplantation : resolution of rejection in the presence of circulating donor-specific antibody
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Higgins, Rob, Hathaway, Mark, Lowe, David Philip, 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. doi:10.1097/01.tp.0000284729.39137.6e ISSN 0041-1337.
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Official URL: http://dx.doi.org/10.1097/01.tp.0000284729.39137.6...
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 | ||||
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| Subjects: | Q Science > QR Microbiology > QR180 Immunology R Medicine > RD Surgery |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Metabolic and Vascular Health (- until July 2016) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | Transplantation | ||||
| Publisher: | Lippincott Williams & Wilkins | ||||
| ISSN: | 0041-1337 | ||||
| Official Date: | 15 October 2007 | ||||
| Dates: |
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| Volume: | Vol.84 | ||||
| Number: | No.7 | ||||
| Number of Pages: | 9 | ||||
| Page Range: | pp. 876-884 | ||||
| DOI: | 10.1097/01.tp.0000284729.39137.6e | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access |
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