May 23, 2012

Pretransplant Donor-Specific HLA Class-I and -II Antibodies Are Associated with an Increased Risk for Kidney Graft Failure

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The recent development of Luminex reagents capable of detecting complement fixing HLA antibodies has sparked a lot of interest in the best way to apply this information. This study examined C1Q-fixing HLA antibodies in a retrospective study of pre-transplant samples in patients transplanted across a negative cytotoxic cross-match. Of the 837 sera examined, 210 contained DSA identified by Luminex single antigen beads. Out of the 210 sera with IgG DSA, only 30 showed C1q-fixing DSA and primarily in re-transplant patients. No significant difference in graft survival was observed between patients with C1q DSA to those with IgG DSA. Although the low number of C1q-DSA+ sera is expected in a population of patients transplanted across negative cytotoxic crossmatches, this study does highlight certain cases where C1q-DSA is likely to be present. Given the reluctance of many transplant centers in North America to transplant across positive flow cytometry crossmatches, the key question remains on the use of C1q-DSA in post-transplant monitoring.

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