Retrospective Antibody Analysis of Thirty Patients with Kidney Graft Failure
T Kinukawa, M Kato, PI Terasaki, M Ozawa
This is one of the first single center longitudinal studies in kidney transplant to investigate the effect of HLA antibodies on allograft outcome.
Retrospective testing of serially collected and stored sera from 76 kidney transplant patients showed that HLA antibodies appeared before failure in 7 patients, but 6 patients failed without demonstrable antibody.
1. No antibodies were found in the sera of 44 patients with continued good function of transplants. There was 148 patient-years of good function in the absence of antibodies.
2. 20 patients showed presence of HLA antibodies but with functional transplants, 12 of them had de novo HLA antibodies with increasing strength during follow up. These are possibly patients at risk for failure.
3. There were 8 patients in whom HLA antibodies appeared within the first few months after transplantation, but then disappeared. It is postulated that responding B cell clones may have been deleted or reduced by immunosuppression.
4. Statistical analysis of association of antibody with failure by patients had a p value of 0.07. When the patients who had transient antibodies were counted as not having antibodies, the p value became 0.003.