Anti-HLA antibodies evolution on kidney transplant of patients sensitized to the donator

Abstract

The purpose was to assess the serum reactivity variation against HLA antigen panel (RCP %) and the persistence of donator-specific antibodies (EDA), in 21 pre-sensitized patients, subject to kidney transplant. The post-transplant follow-up time varied from 5 days to 6 years, while, in 76.2% of cases, it was shorter than 12 months. Three patients received the graft derived from related donor and other, from deceased donor. They all presented negative cross matching and some RCP level, including antibodies against donator&";s antigens on pre-transplant assessment. The antibodies were investigated, employing the Mutiplex Luminex® technology, with LABScreen Single Antigen and PRA kits, expressed in MFI (mean fluorescence intensity) and analyzed in the computer program EpVix. The EDA antibodies persistence occurred in 8 (66.7%) cases with class I anti-HLA, with MFI decrease up to 35%, in 4 of them. The RCP remained unchanged or with slight increase (≤13 percentage points). In other two cases, new types were developed and the RCP increased up to 20 percentage points. For the antibodies against class II antigens, there was the persistence of all of them, with increase on the MFI value. In one case, there was also the development of new HLA-DR specificity. The RPC increased in only one case, despite of not having generated new antibodies for the donator&";s antigens. In conclusion, the information suggests that antibodies against class II HLA antigens are more difficult to be controlled, on post-kidney transplant when compared to the ones directed to the class I HLA.