Introduction

Renal allograft nephrectomy is a major risk factor for anti-HLA alloimmunization and antibody-mediated rejection after retransplantation. No preventive strategy has been evaluated.

Methods

We retrospectively analyzed anti-HLA DSA and non-DSA, using Luminex technology, in 58 patients presented with renal allograft nephrectomy between 2005 and 2010. For each patient, anti-HLA antibodies were assessed at the time of nephrectomy, 3 and 12 months after. Twenty-one (36%) were treated with intravenous immunoglobulins (IVIg) (1.5g/kg).

Results

Renal allograft nephrectomy was performed for intolerance graft syndrome (IGS) more than 6 months after transplant in 17 (81%) treated patients (TT) and in 15 (41%) untreated (UT) (p=0.005). After 12 months, only calculated PRA (cPRA) increased significantly in UT (p=0.004) and not in TT (p=0.05) although non DSA and DSA alloimmunization remained comparable in both groups.

Patients without DSA at the time of nephrectomy (TT N=7; NT N=12) exhibited similar anti-HLA non-DSA characteristics in both groups. Five (71%) TT patients vs. 2 (16%) UT presented with IGS (p=0.04). After 3 and 12 months, class I and class II DSA and non-DSA were significantly higher in UT group compare to TT group. TT group only increased significantly number of class I non-DSA with MFI > 1000. After 3 months, increase of class I non-DSA median number (MFI > 1000) and of non-DSA MFI max were significantly lower in TT group (50% vs. 96% (p=0.04); 21% vs. 87% (p=0.02) respectively). At 12 months, cPRA was significantly higher in UT group compared to TT group (p=0.04).

Conclusion

IVIg at the time of nephrectomy is likely to decrease cPRA 12 months after allograft nephrectomy and could improve waiting time for retransplantation.

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