Kidney transplantation in patients with antibodies against donor HLA class II

H. S. Pollinger, Mark D Stegall, J. M. Gloor, S. B. Moore, S. R. Degoey, N. A. Ploeger, W. D. Park

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

The immunologic risk associated with donor-specific antibodies (DSA) against Class II human leukocyte antigens (HLA) in kidney transplant (KTx) recipients is unclear. The aim of this study was to determine the outcome of KTx when DSA was detected only against HLA Class II. To isolate the impact of anti-Class II DSA, we retrospectively analyzed 12 KTx recipients who at baseline had a positive B-cell flow cytometric crossmatch (FXM) and a negative T-cell FXM. Using alloantibody specification analysis, 58.3% (7/12) had DSA against donor Class II and 41.7% had no demonstrable DSA. Biopsy-proven AMR occurred in 57% (4/7) in the Class II+ group and 0% in the Class II- group (p > 0.05). Peritubular capillaries stained positive for C4d in 86% (6/7) of the Class II+ patients and in 40% (2/5) of the Class II - patients (p > 0.05). One patient in the Class II+ group lost their graft at 3 months to accelerated transplant glomerulopathy, while all other grafts were functioning 3-37 months posttransplant despite the persistence of anti-Class II DSA. We conclude that KTx recipients with clearly defined anti-Class II DSA are at risk for humoral rejection suggesting that desensitization and/or close posttransplant monitoring may be needed to prevent AMR.

Original languageEnglish (US)
Pages (from-to)857-863
Number of pages7
JournalAmerican Journal of Transplantation
Volume7
Issue number4
DOIs
StatePublished - Apr 2007

Fingerprint

HLA Antigens
Kidney Transplantation
Tissue Donors
Antibodies
Transplants
HLA-D Antigens
Isoantibodies
Immunoglobulin Isotypes
B-Lymphocytes
T-Lymphocytes
Kidney
Biopsy

Keywords

  • Class II antibody
  • Donor specific antibody
  • Flow cytometric cross match
  • Human leukocyte antigen
  • Kidney transplant
  • Positive cross match
  • Single antigen flow bead

ASJC Scopus subject areas

  • Immunology

Cite this

Pollinger, H. S., Stegall, M. D., Gloor, J. M., Moore, S. B., Degoey, S. R., Ploeger, N. A., & Park, W. D. (2007). Kidney transplantation in patients with antibodies against donor HLA class II. American Journal of Transplantation, 7(4), 857-863. https://doi.org/10.1111/j.1600-6143.2006.01699.x

Kidney transplantation in patients with antibodies against donor HLA class II. / Pollinger, H. S.; Stegall, Mark D; Gloor, J. M.; Moore, S. B.; Degoey, S. R.; Ploeger, N. A.; Park, W. D.

In: American Journal of Transplantation, Vol. 7, No. 4, 04.2007, p. 857-863.

Research output: Contribution to journalArticle

Pollinger, H. S. ; Stegall, Mark D ; Gloor, J. M. ; Moore, S. B. ; Degoey, S. R. ; Ploeger, N. A. ; Park, W. D. / Kidney transplantation in patients with antibodies against donor HLA class II. In: American Journal of Transplantation. 2007 ; Vol. 7, No. 4. pp. 857-863.
@article{a352747ccfee400a8e03ae8a3c30e015,
title = "Kidney transplantation in patients with antibodies against donor HLA class II",
abstract = "The immunologic risk associated with donor-specific antibodies (DSA) against Class II human leukocyte antigens (HLA) in kidney transplant (KTx) recipients is unclear. The aim of this study was to determine the outcome of KTx when DSA was detected only against HLA Class II. To isolate the impact of anti-Class II DSA, we retrospectively analyzed 12 KTx recipients who at baseline had a positive B-cell flow cytometric crossmatch (FXM) and a negative T-cell FXM. Using alloantibody specification analysis, 58.3{\%} (7/12) had DSA against donor Class II and 41.7{\%} had no demonstrable DSA. Biopsy-proven AMR occurred in 57{\%} (4/7) in the Class II+ group and 0{\%} in the Class II- group (p > 0.05). Peritubular capillaries stained positive for C4d in 86{\%} (6/7) of the Class II+ patients and in 40{\%} (2/5) of the Class II - patients (p > 0.05). One patient in the Class II+ group lost their graft at 3 months to accelerated transplant glomerulopathy, while all other grafts were functioning 3-37 months posttransplant despite the persistence of anti-Class II DSA. We conclude that KTx recipients with clearly defined anti-Class II DSA are at risk for humoral rejection suggesting that desensitization and/or close posttransplant monitoring may be needed to prevent AMR.",
keywords = "Class II antibody, Donor specific antibody, Flow cytometric cross match, Human leukocyte antigen, Kidney transplant, Positive cross match, Single antigen flow bead",
author = "Pollinger, {H. S.} and Stegall, {Mark D} and Gloor, {J. M.} and Moore, {S. B.} and Degoey, {S. R.} and Ploeger, {N. A.} and Park, {W. D.}",
year = "2007",
month = "4",
doi = "10.1111/j.1600-6143.2006.01699.x",
language = "English (US)",
volume = "7",
pages = "857--863",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Kidney transplantation in patients with antibodies against donor HLA class II

AU - Pollinger, H. S.

AU - Stegall, Mark D

AU - Gloor, J. M.

AU - Moore, S. B.

AU - Degoey, S. R.

AU - Ploeger, N. A.

AU - Park, W. D.

PY - 2007/4

Y1 - 2007/4

N2 - The immunologic risk associated with donor-specific antibodies (DSA) against Class II human leukocyte antigens (HLA) in kidney transplant (KTx) recipients is unclear. The aim of this study was to determine the outcome of KTx when DSA was detected only against HLA Class II. To isolate the impact of anti-Class II DSA, we retrospectively analyzed 12 KTx recipients who at baseline had a positive B-cell flow cytometric crossmatch (FXM) and a negative T-cell FXM. Using alloantibody specification analysis, 58.3% (7/12) had DSA against donor Class II and 41.7% had no demonstrable DSA. Biopsy-proven AMR occurred in 57% (4/7) in the Class II+ group and 0% in the Class II- group (p > 0.05). Peritubular capillaries stained positive for C4d in 86% (6/7) of the Class II+ patients and in 40% (2/5) of the Class II - patients (p > 0.05). One patient in the Class II+ group lost their graft at 3 months to accelerated transplant glomerulopathy, while all other grafts were functioning 3-37 months posttransplant despite the persistence of anti-Class II DSA. We conclude that KTx recipients with clearly defined anti-Class II DSA are at risk for humoral rejection suggesting that desensitization and/or close posttransplant monitoring may be needed to prevent AMR.

AB - The immunologic risk associated with donor-specific antibodies (DSA) against Class II human leukocyte antigens (HLA) in kidney transplant (KTx) recipients is unclear. The aim of this study was to determine the outcome of KTx when DSA was detected only against HLA Class II. To isolate the impact of anti-Class II DSA, we retrospectively analyzed 12 KTx recipients who at baseline had a positive B-cell flow cytometric crossmatch (FXM) and a negative T-cell FXM. Using alloantibody specification analysis, 58.3% (7/12) had DSA against donor Class II and 41.7% had no demonstrable DSA. Biopsy-proven AMR occurred in 57% (4/7) in the Class II+ group and 0% in the Class II- group (p > 0.05). Peritubular capillaries stained positive for C4d in 86% (6/7) of the Class II+ patients and in 40% (2/5) of the Class II - patients (p > 0.05). One patient in the Class II+ group lost their graft at 3 months to accelerated transplant glomerulopathy, while all other grafts were functioning 3-37 months posttransplant despite the persistence of anti-Class II DSA. We conclude that KTx recipients with clearly defined anti-Class II DSA are at risk for humoral rejection suggesting that desensitization and/or close posttransplant monitoring may be needed to prevent AMR.

KW - Class II antibody

KW - Donor specific antibody

KW - Flow cytometric cross match

KW - Human leukocyte antigen

KW - Kidney transplant

KW - Positive cross match

KW - Single antigen flow bead

UR - http://www.scopus.com/inward/record.url?scp=33947604071&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33947604071&partnerID=8YFLogxK

U2 - 10.1111/j.1600-6143.2006.01699.x

DO - 10.1111/j.1600-6143.2006.01699.x

M3 - Article

C2 - 17295642

AN - SCOPUS:33947604071

VL - 7

SP - 857

EP - 863

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 4

ER -