Date: Sunday, June 12, 2016
Session Name: Concurrent Session: Kidney AMR: Making the Diagnosis
Session Time: 4:30pm-6:00pm
Presentation Time: 5:18pm-5:30pm
Location: Veterans Auditorium
Background: The mechanism leading to the appearance of anti-HLA antibodies and donor-specific antibodies (DSAs) after an allograft nephrectomy (NTx) is not fully understood. Two mechanisms have been advocated: (i) at graft loss, DSAs are not detected in the serum because they are fixed on the non-functional transplant, and are released after NTx; (ii) NTx itself is responsible for de novo anti-HLA immunization against residual donor tissue. The aims of our study were to compare anti-HLA antibodies present in the serum and graft at the time of an allograft nephrectomy, and to assess the timing and kinetics of their appearance after an allograft nephrectomy.
Methods: Seventeen patients have undergone NTx, 4 (3-33) months after graft loss. Immunosuppression had been stopped in all patients at least three months before NTx. Anti-HLA antibodies were assessed in the serum before, and 1, 5, 30, and 90 days after NTx. In addition, fragments of the removed kidney allograft were eluted to characterized intra-graft anti-HLA Abs. Anti-HLA antibodies were analyzed using the Luminex Single antigen assay.
Results:, On 14 patients with anti-HLA antibodies in the serum at NTx, 11 patients had anti-HLA antibodies fixed in the kidney allograft. No anti-HLA antibodies were detected in the graft if they were also not detected in the serum. Eleven of the 12 patients who had DSAs detected in their sera also had DSAs detected in the grafts. A positive C4d staining was positive in 9 of the 11 patients. Epitopic analysis revealed that most anti-HLA antibodies detected in removed grafts were directed against the donor. All de novo Anti-HLA antibodies and DSAs were detected ≥ 1 month after NTx. Interestingly, none of the de novo anti-HLA antibodies had been previously detected in the graft.
Conclusion: Our data suggest that anti-HLA sensitization after NTx is related to the NTx itself rather than to a release of fixed anti-HLA antibodies from the failed kidney.
CITATION INFORMATION: Milongo D, Congy-Jolivet N, Del Bello A, Sallusto F, Esposito L, Rostaing L, Kamar N. Analysis of Intra-Graft Anti-HLA Antibodies Suggests That HLA Sensitization Occurs Long After an Allograft Nephrectomy and Is Not Due to a Release of Anti-HLA Antibodies from the Failed Kidney. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Milongo D, Congy-Jolivet N, Del A, Sallusto F, Esposito L, Rostaing L, Kamar N. Analysis of Intra-Graft Anti-HLA Antibodies Suggests That HLA Sensitization Occurs Long After an Allograft Nephrectomy and Is Not Due to a Release of Anti-HLA Antibodies from the Failed Kidney. [abstract]. Am J Transplant. 2016; 16 (suppl 3). http://atcmeetingabstracts.com/abstract/analysis-of-intra-graft-anti-hla-antibodies-suggests-that-hla-sensitization-occurs-long-after-an-allograft-nephrectomy-and-is-not-due-to-a-release-of-anti-hla-antibodies-from-the-failed-kidney/. Accessed December 18, 2017.
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