The Relevance of Naturally Occurring Non-HLA Antibody to Antibody Mediated Rejection in Patients without Anti-HLA Antibodies After Kidney Transplantation

H. Ishida¹, T. Shimizu², K. Unagami³, H. Shirakawa¹, K. Tanabe¹

¹Tokyo Womens, Tokyo 162-8666, Japan, ²Urology, Tokyo Womens, Tokyo 162-8666, Japan, ³Nephrology, Tokyo Womens, Tokyo 162-8666, Japan

Meeting: 2021 American Transplant Congress

Abstract number: 915

Keywords: Alloantibodies, Antibodies

Topic: Clinical Science » Kidney » Kidney Immunosuppression: Desensitization

Session Information

Session Name: Kidney Immunosuppression: Desensitization

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Very few papers describe the association between non-HLA antibodies and the incidence of antibody mediated rejection (AMR) in kidney recipients. We investigated the incidence rate of AMR in recipients with or without non-HLA antibody and anti-HLA antibodies (DSA).

*Methods: The sample serum was collected from 130 recipients before kidney transplantation. Basically, all patients with DSA detected by Luminex received desensitized protocol including low-dose rituximab and plasmapheresis to remove DSA prior to transplantation. In contrast, except for patients with DSA, none received desensitization protocol. The frequencies of AMR due to non-HLA antibodies was examined.

*Results: Totally 130 recipients were divided into 4 groups according to the presence of HLA antibodies (DSA) and non-HLA antibodies as follows; G1: DSA+/non-HLA Ab+ N=21; G2: DSA+/non-HLA Ab- N=3; G3: DSA-/non-HLA Ab+ N=76; G4: DSA-/non-HLA Ab- N=30. In G1, 5 of 21 (5/21, 24%) showed active and chronic AMR, each one did BK viral infection, TMR and IFTA. In G2, 1 of 3 showed AMR. In G3, 5 (5/76, 7%) recipients showed AMR. Two showed TMA. Totally, 7 of 76 (7/76, 9%) in G3 showed AMR and suspicious AMR. These 7 recipients with AMR, probably due to the presence of non-HLA antibodies, were completely rescued by postoperative desensitized treatments including rituximab administration and plasmapheresis. The remaining 30 recipients in G4 without DSA as well as non-HLA antibodies showed no AMR after kidney transplantation.

*Conclusions: Immediately after kidney transplantation, non-HLA antibody seems to be capable of causing AMR, however, followed by complete recovery from AMR by the antibody removal treatment postoperatively. In recipients with non-HLA antibodies, the incidence rate of AMR is not so high and its intensity is not so severe, compared to HLA antibodies (DSA), although further examination is needed for understanding long-term influence of non-HLA antibodies after kidney transplantation.

To cite this abstract in AMA style:

Ishida H, Shimizu T, Unagami K, Shirakawa H, Tanabe K. The Relevance of Naturally Occurring Non-HLA Antibody to Antibody Mediated Rejection in Patients without Anti-HLA Antibodies After Kidney Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/the-relevance-of-naturally-occurring-non-hla-antibody-to-antibody-mediated-rejection-in-patients-without-anti-hla-antibodies-after-kidney-transplantation/. Accessed June 3, 2025.

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