Detection of HLA and MICA Antibodies Before Kidney Graft Failure
K Mizutani, L shibata, M Ozawa, V Esquenazi, A Rosen, J Miller, PI Terasaki
This is one of the first single center longitudinal studies in kidney transplant to investigate the effect of HLA antibodies on allograft outcome.
90 serum samples taken from a series of 28 patients who lost their grafts were retrospectively investigated for antibodies by single antigen HLA Class I&II and MICA Luminex beads. In 20 patients with immunological failure, 10 patients had DSA, 16 had epitope-related NDSA, and 16 had NDSA or MICA antibodies. In 16 which increased antibodies leading up to the graft failure, DSA were found in 7 patients. However, in 9 patients who similarly rejected their grafts, 6 were epitope-related DSA and 3 were NDSA. We were unable to establish why NDSA might be associated with the failure, but this was clearly the case in these patients. Of the 25 patients whose grafts were rejected, 23 (92%) produced antibody prior to failure.
Our results strongly suggest that antibody monitoring is important as a means of detecting chronic rejection before a rise in SCr. Early detection of antibody would allow for appropriate and timely interventions to save a graft.