Evaluation of anti-human leukocyte antigen allo-immunization in pediatric cadaveric kidney transplantation

• Published in: Pediatric transplantation Vol. 4; no. 1; pp. 6 - 11
• Main Authors: Emonds, M. -P., Herman, J., Dendievel, J., Waer, M., Van Damme-lombaerts, R.
• Format: Journal Article
• Language: English
• Published: Copenhagen, Denmark Munksgaard International Publishers 01.02.2000; Blackwell
• Subjects: Biological and medical sciences; Cadaver; Child; Cytotoxicity Tests, Immunologic; Graft Rejection - immunology; Graft Survival; Histocompatibility Testing; HLA Antigens - immunology; Humans; Immunoenzyme Techniques; Isoantibodies - analysis; Kidney Transplantation; kidney transplantationanti-HLA antibodiesallo-immunizationhistocompatibility testingHLA crossmatchrejection; kidney transplantation anti‐HLA antibodies allo‐immunization histocompatibility testing HLA crossmatch rejection; Medical sciences; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Human; Postoperative; HLA-System; Prognosis; Antibody; Leukocyte; Acute; Major histocompatibility system; Transplantation; Homotransplantation; Kidney; Rejection; Surgery; Risk factor; Predictive value; Preoperative; Child
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1034/j.1399-3046.2000.00075.x

: Forty‐eight pediatric cadaveric renal transplantations, performed between May 1986 and February 1997, were retrospectively screened, pre‐ and post‐transplant, for antibodies to human leukocyte antigen (anti‐HLA) using complement‐dependent cytotoxicity (CDC) assay and enzyme immunoassay (EIA). The correlation between anti‐HLA immunization and graft outcome was investigated. The combined analysis of CDC and EIA enabled the differentiation between complement‐fixing and non‐complement‐fixing, anti‐HLA class I and anti‐HLA class II antibodies. The median post‐transplant follow‐up for all patients with a functioning graft was 86 months (range 10–138 months). In the whole population, 16 grafts were lost: six following a non‐immunologic complication; and 10 as a result of rejection. Of these 10 grafts lost, eight were in patients with pre‐ and/or post‐transplant donor antigen specific (DAS) anti‐HLA class I or class I + II antibodies; and two were in patients with DAS anti‐HLA class II antibodies only. Three of these grafts were lost in patients with weak pre‐existing DAS anti‐HLA class I antibodies. Immunological graft loss appeared at a median post‐transplant time of 38 months (range 2–68 months). All patients without DAS anti‐HLA antibodies had a good graft outcome. The presence of pre‐ and post‐transplant DAS anti‐HLA antibodies, especially if directed against HLA class I, were associated with a poor graft outcome. A systematic search for, and identification of, anti‐HLA antibodies should therefore be part of a pretransplant evaluation to allow the identification of ‘unacceptable’ donor HLA antigens, following which the impact of the HLA‐cross‐match on graft outcome will improve. Screening for DAS anti‐HLA antibodies post‐transplant could be helpful for detecting patients with an increased risk for graft loss following rejection episodes.