Changes in anti-HLA antibody levels associated with immunosuppression

One of the most difficult problems in clinical renal transplantation is the disposition of patients with preformed antibody directed against HLA antigens. The pool of patients untransplantable because of persistently positive crossmatches is growing. Approaches to this problem have included transplantation of patients with remote (noncurrent) positive crossmatches but current (day of transplant) negative crossmatches. In order to increase the number of patients for whom this strategy might be useful, it will be necessary to design therapies to decrease anti-HLA antibodies in patients who are sensitized. Approaches to this problem have included plasmapheresis and immunosuppression for short periods of time. To assess the potential efficacy of longer periods of immunosuppression, whe have retrospectively analyzed cytotoxic antibody levels in four groups of patients.