Objectives:1) To evaluate the incidence of development of anti-HLA antibodies on the long run in our renal transplant population and the main risk factors for their development or persistence. 2) To investigate the impact of the antibodies(by Luminex®) on renal function and graft survival. Method. A retrospective cohort study that included 372 patients that received a renal graft from January 2005 to December 2010 at our centre. Results. At a mean of 5 years post-transplantation, the presence of anti-HLA antibodies was detected in 30% (90/281) of our population, from which one third were donor-specific. The distribution of patients with antibodies according to their type was as follows: Class I 34.5%, Class II 29%, Class I and II 36.5%. Out of the pretransplant sensitized patients, 35/51 remained with positive antibodies after transplantation, while 55/230 patients developed de novo anti-HLA antibodies. The risk factors for persistence/positive antiHLA antibodies were: acute humoral rejection [4.23(2.13- 8.41), p<0.001], pretransplant allosensitization [3.95(2.37-6.55), p<0.001], retrasplantation [8.71(4.26-17.79), p<0.001], ≥4 HLA incompatibility [1.83(1.02-3.42), p=0.049], mean tacrolimus levels of <6 ng/ml [2.17(1.12-4.92), p=0.048]. There were no differences between different induction or maintenance immunosuppressants (30% with mTOR inhibitors). In the multivariate analysis, the independent factor for persistence of anti-HLA antibodies in pretransplant sensitized patients was having a previous transplant [13.50(2.74-66.51), p=0.001], while in those patients who developed de novo anti-HLA antibodies the main factor was having mean tacrolimus blood levels of <6 ng/ml [2.43(1.09-6.72), p=0.047). Patients who had Class I and II anti-HLA antibodies had worse renal function [eGFR 47(19)vs 54(17) ml/min] and a lower 5-year graft survival rate (59.5% vs 94.5%). Conclusion. Allosensitization due to a previous transplant and low levels of tacrolimus seem to be the main risk factors for persistence or development of anti-HLA antibodies in the long-term. Their presence cause worse renal function and lower graft survival, so our priority should be its prevention.

CITATION INFORMATION: Perez-Flores I, Santiago J, Rodriguez-Cubillo B, Moreno De La Higuera M, Lopez De La Manzanara V, Bautista-Cañas J, Calvo Romero N, Shabaka A, Urcelay E, Sanchez-Fructuoso A. Long-Term Persistence of Anti-HLA Antibodies in Renal Trasplant Recipients: Risk Factors and Impact on Clinical Course. Am J Transplant. 2017;17 (suppl 3).

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