Donor-specific HLA Antibody Response in Clonal Deletion.

Kaneku H, Idica A, Everly MJ, Terasaki PI, Feroz A, Vanikar AV, Shankar V, Trivedi VB, Modi PR, Khemchandani SI, Dave SD, Trivedi HL.

Clinical Transplants 2008, Chapter 18

Abstract

1. A total of 61 patients were treated with a clonal deletion protocol and transplanted without planned post-transplant immunosuppression. 2. Twenty-nine (48%) patients did not develop any donor-specific anti-HLA antibodies after the transplant, with a median follow-up of 158 days and a mean sCr of 2.1 mg/dL at the last follow-up. 3. Only 23% of the patients who received a DST of 60 mL produced DSA after the transplant, while 68% of the patients who received a bigger DST dose did. 4. Small doses of donor-specific transfusions (60 mL) elicited smaller specific responses, allowing efficient deletion of the reacting clones, creating conditions in which donor-specific anti-HLA antibodies were not produced. 5. A better deleting agent is needed to achieve higher rates of success using the clonal deletion protocol.