Summary of the effect of de novo HLA antibodies on chronic kidney graft failure.

1. Roughly 26% of patients post-transplantation have de novo HLA antibodies. 2. In patients monitored at frequent intervals, patients who had no antibodies had 528 patient-years of survival with good function. The absence of antibodies is therefore associated with function. 3. Retrospective analyses of serial serum samples of 93 patients from four centers who had graft failure revealed that 80 (86%) had HLA and/or MICA antibodies. 4. In the Greenville and Nagoya studies, 45% of patients with graft failure had DQ antibodies, and 28% patients had MICA antibodies. 5. De novo antibodies developed on average approximately 1 year after transplantation, and led to an increase in serum creatinine > 2mg/dl in an average of 29 months and graft failure in 44 months. 6. From the Maastricht and Greenville studies, after development of antibodies, the half life for kidney grafts was 5 years. 7. In three independent prospective studies, patients with antibodies had a half life of 12.2, 8.6, and 7.5 years. In contrast, those without antibodies had a half life of 39.5, 33.2, and 24.6 years. 8. In prospective studies, both heart and lung transplant patients with antibodies had a significantly lower graft survival than those without antibodies. 9. Eight patients who transiently developed antibodies early after transplantation are of potential interest since they may be patients in whom stimulated clones of plasma cells were deleted. Alternatively, they may represent patients in whom antibodies were eliminated with subsequent good function compared to those in whom antibodies continued to rise, leading to graft failure.