Laura Riesco1, Juan Irure2, Emilio Rodrigo3, Sandra Guiral4, Juan Carlos Ruiz5, Javier Gómez6, Marcos López-Hoyos7, David San Segundo8. 1. Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain. Electronic address: laura.riesco@scsalud.es. 2. Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain. Electronic address: juan.irure@scsalud.es. 3. Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain. Electronic address: emilio.rodrigo@scsalud.es. 4. Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain. Electronic address: sandraalmudena.guiral@scsalud.es. 5. Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain. Electronic address: juancarlos.ruiz@scsalud.es. 6. Pathology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain. Electronic address: josejavier.gomez@scsalud.es. 7. Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain. Electronic address: marcos.lopez@scsalud.es. 8. Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain. Electronic address: david.sansegundo@scsalud.es.
Abstract
BACKGROUND: The improvement in the definition of serum anti-HLA antibodies (HLA-Abs) profiles after Luminex-assay implementation in transplant patients follow-up is clear. This success has permitted the development of hypersensitized-recipient allocation and donor-paired exchange programs improving the access to transplantation. However, non-HLA Abs have been described in transplanted patients but their effect in hypersensitized transplanted recipients is unclear. METHODS: Twenty-seven HLA hypersensitized patients awaiting for kidney transplantation (KT) were studied and 11 of them were followed after KT. The HLA Abs profile was confirmed in serum by Single Antigen Luminex assay and panel reactive of antigens >98% was achieved in all patients. Subsequently, the ability to fix complement by C1q test was also assessed. Serum non-HLA Abs before and 1 month after transplantation were measured in the 11 hypersensitized recipients. RESULTS: 95.2% of the hypersensitized on waiting list had concomitant serum anti-HLA and non-HLA Abs. The more frequent specificity in non-HLA Abs were found against Glutathione S-transferase theta-1 (GSST-1) (in 62%) and C-terminal fragment of perlecan (LG3) (in 52%). Four out of 11 transplanted patients presented early antibody-mediated rejection (ABMR) confirmed by biopsy and had serum anti-LG3 antibodies, two of them with concomitant anti-anti-angiotensin II type I receptor. Only one patient developed de novo-donor specific HLA antibodies. CONCLUSIONS: The incidence of non-HLA antibodies in patients in the waiting list is largely underestimated. The concomitance anti-HLA and non-HLA Abs in hypersensitized patients is very common and the detection of non-HLA Abs in this population could allow to identify patients with an increased risk of humoral rejection.
BACKGROUND: The improvement in the definition of serum anti-HLA antibodies (HLA-Abs) profiles after Luminex-assay implementation in transplant patients follow-up is clear. This success has permitted the development of hypersensitized-recipient allocation and donor-paired exchange programs improving the access to transplantation. However, non-HLA Abs have been described in transplanted patients but their effect in hypersensitized transplanted recipients is unclear. METHODS: Twenty-seven HLA hypersensitizedpatients awaiting for kidney transplantation (KT) were studied and 11 of them were followed after KT. The HLA Abs profile was confirmed in serum by Single Antigen Luminex assay and panel reactive of antigens >98% was achieved in all patients. Subsequently, the ability to fix complement by C1q test was also assessed. Serum non-HLA Abs before and 1 month after transplantation were measured in the 11 hypersensitized recipients. RESULTS: 95.2% of the hypersensitized on waiting list had concomitant serum anti-HLA and non-HLA Abs. The more frequent specificity in non-HLA Abs were found against Glutathione S-transferase theta-1 (GSST-1) (in 62%) and C-terminal fragment of perlecan (LG3) (in 52%). Four out of 11 transplanted patients presented early antibody-mediated rejection (ABMR) confirmed by biopsy and had serum anti-LG3 antibodies, two of them with concomitant anti-anti-angiotensin II type I receptor. Only one patient developed de novo-donor specific HLA antibodies. CONCLUSIONS: The incidence of non-HLA antibodies in patients in the waiting list is largely underestimated. The concomitance anti-HLA and non-HLA Abs in hypersensitizedpatients is very common and the detection of non-HLA Abs in this population could allow to identify patients with an increased risk of humoral rejection.
Authors: Sergi Clotet-Freixas; Max Kotlyar; Caitriona M McEvoy; Chiara Pastrello; Sonia Rodríguez-Ramírez; Sofia Farkona; Heloise Cardinal; Mélanie Dieudé; Marie-Josée Hébert; Yanhong Li; Olusegun Famure; Peixuen Chen; S Joseph Kim; Emilie Chan; Igor Jurisica; Rohan John; Andrzej Chruscinski; Ana Konvalinka Journal: Transplant Direct Date: 2021-09-20