Rises and Falls in Donor-Specific and Third-Party HLA Antibody Levels After Antibody Incompatible Transplantation

Authors:
  • DLDavid Lowe
    David Lowe
  • MHMark Hathaway
    Mark Hathaway
  • FLFor Lam
    For Lam
  • HKHabib Kashi
    Habib Kashi
  • LTLam Chin Tan
    Lam Chin Tan
  • CIChris Imray
    Chris Imray
  • SFSimon Fletcher
    Simon Fletcher
  • KCKlaus Chen
    Klaus Chen
  • NKNithya Krishnan
    Nithya Krishnan
  • RHRizwan Hamer
    Rizwan Hamer
  • DZDaniel Zehnder
    Daniel Zehnder
Publisher website
Google Scholar
Abstract
After human leukocyte antigen (HLA) antibody-incompatible transplantation, donor specific and third party HLA antibodies may be found, and their levels fall in a donor-specific manner during the first month. However, these changes have not been previously described in detail. Donor-specific HLA antibody (DSA) and third-party HLA antibody (TPA) levels were measured using the microbead method in 44 presensitized patients who had renal transplantation. DSA+TPA fell in the first 4 days after transplantation, and greater falls in DSA indicated absorption by the graft. This occurred for class I (57.8% fall compared with 20.2% for TPA, P<0.0005), HLA DR (63.0% vs. 24.3%, P<0.0004), and for HLA DP/DQ/DRB3-4 (34% vs. 17.5%, P=0.014). Peak DSA levels occurred at a mean of 13 days posttransplant, and they were higher than pretreatment in 25 (57%) patients and lower in 19 (43%) patients (P=ns). The risk of rejection was associated with peak DSA levels; 15 of 25 (60%) patients with DSA at median fluorescence intensity (MFI) more than 7000U experienced rejection, compared with 4 of 7 (57%) patients with peak DSA MFI 2000 to 7000U, and 2 of 12 (17%) patients with peak DSA MFI less than 2000U (P<0.02). DSA levels subsequently fell in a donor specific manner compared to TPA. DSA levels may change markedly in the first month after antibody incompatible transplantation, and the risk of rejection was associated with higher pretreatment and peak levels.

This publication has 18 references indexed in Scilit: