Increases in titer or de novo production of HLA antibody are potential sequelae of pregnancy, transfusion, or transplantation. It has also been reported that pro-inflammatory events such as infection and trauma may lead to changes in HLA alloantibodies (Ab). To explore the potential risk of apparent HLA sensitization associated solely with surgical procedures, a cohort of patients undergoing cardiac surgery with bypass but without transfusion was tested for HLA Ab pre- and post-surgery.

A total of 123 patients were consented and enrolled in this prospective study. Each patient was tested for the presence of HLA Ab at three separate time points; prior to surgery, 4-22 days (average 10.62 days) post-surgery, and 16-48 days (average 28.78 days) post-surgery. Sera were initially tested by a screening assay; any samples exhibiting reactivity were also tested using single-antigen bead microarrays to determine the specificity of the HLA Ab. If HLA Ab was present in any sample, all of the subject’s samples were tested for specificity in the same assay.

Of the 79 patients who did not have detectable HLA Abs prior to surgery, 3 had HLA Abs post-surgery (3.8%). In contrast, 12 of 44 patients (27%) exhibiting pre-surgery sensitization demonstrated an increase in HLA Ab titer or additional specificities following surgery (p < .001).

This data demonstrates that invasive surgical procedures may lead to increased rates of HLA antibody production, particularly in patients who have been previously sensitized against HLA. The presence of HLA Abs significantly affects the access and outcome of organ transplant recipients. Potential transplant recipients undergoing surgical procedures, even in the absence of blood transfusions, should be tested for HLA Ab following the procedure.

« Back to 2013 American Transplant Congress