High Panel Reactive Antibody against Cross-Reactive Group Antigens as a Contraindication to Renal Allotransplantation

• Published in: Experimental and molecular pathology Vol. 71; no. 1; pp. 73 - 78
• Main Authors: Dilioglou, Smaroula, Cruse, Julius M., Lewis, Robert E.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.08.2001; Elsevier
• Subjects: Adult; Biological and medical sciences; Contraindications; Cross Reactions; Flow Cytometry; HLA Antigens - immunology; Humans; Isoantibodies - blood; Kidney Transplantation - immunology; Longitudinal Studies; Medical sciences; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Time Factors; Human; Graft(material); HLA-System; Transplantation; Homotransplantation; Kidney; Rejection; Surgery; Alloantibody; Cross reaction; Adult; Contraindication; Hyperacute
• ISSN: 0014-4800; 1096-0945
• DOI: 10.1006/exmp.2001.2356

Preformed circulating cytotoxic IgG anti-HLA alloantibodies induced by previous failed grafts, blood transfusion, or pregnancy are a contraindication to allotransplantation and result in hyperacute rejection. These persistent, highly cytotoxic panel reactive antibodies (PRAs) may be specific for epitopes that are shared among HLA antigens known as cross-reactive groups (CREGs). The present investigation includes 24 subjects awaiting renal transplants with flow cytometric PRAs >30%. Eighty-seven percent of the patients developed alloantibodies specific for the mismatched antigens of previous failed grafts. The complement-dependent cytotoxicity test revealed that A1 and A2 antigens were highly immunogenic, whereas A23, B35, and B7 were less so. All patients who formed anti-A1 and anti-A2 also had developed alloantibodies specific for other antigens of the 1C and 2C CREGs, respectively. The presence of anti-class II HLA alloantibodies led to poor graft survival, i.e., a maximum of 2 years.