Korean J Transplant.  2022 Nov;36(Supple 1):S106. 10.4285/ATW2022.F-2255.

Effect of preexisting human leukocyte antigen donor-specific antibodies especially human leukocyte antigen-DQ on kidney transplant outcome

• Mehrotra S
• Sharma R
• Kapoor R
• Agarwal M
• Kumar A
• Bhaskar V

• KMID: 2535622
• DOI: http://doi.org/10.4285/ATW2022.F-2255

Abstract

Background
Luminex based anti-human leukocyte antigen (HLA) antibody assay to detect donor-specific antibodies (DSA) sin-gle antigen bead (SAB) assay a useful tool for pretransplant immunologic risk evaluation.
Methods
One-hundred-nineteen prospective kidney recipients in our study group, were evaluated for pretransplant HLA sen-sitization by SAB for HLA class I and class II antibodies, CDC cross match was negative in all, three had T cells and one had borderline B cells flow cross match positive. Total 100 Kidney transplants were performed with follow-up of 2 years, where 19 kidney transplants were ABO-incompatible.
Results
Thirty-four recipients had class I (mean fluorescence intensity [MFI], 9057-757), anti HLA-A antibodies were detect-ed in 15 recipients (MFI, 2084-975), HLA-B antibodies in 16 recipients (MFI, 9057-877), HLA-C antibodies in three recipients (MFI, 1715-944), 85 were negative for HLA antibodies. Of 34 only five were had DSA (MFI, 2084-822), there was no episode of rejection. Nine recipients were both class I and class II antibodies which were not donor-specific. Thirty-eight of recipients had class II SAB positive, HLA-DRB1 antibodies in seven recipients (MFI, 3634-795), HLA-DQ in 20 recipients (MFI, 7725-766), HLADP in eight recipients (MFI, 1715-944), HLA-DRB3 antibodies (MFI, 896), HLA-DRB4 antibodies (MFI, 1369) and HLA-DRB5 (MFI, 792) antibodies each in three recipients. Out of 20 who had HLA-DQ antibodies (MFI, 7725-776) only eight were donor-specific. HLA-DQ DSA recipients one was ABO-incompatible transplant who had ABMR posttransplant (MFI, 7725-2555), all of eight HLA-DQ DSA recipients posttransplant SAB MFI came down with in a month. Seven recipients had no episode of rejection.
Conclusions
In class II SAB positivity with HLA-DQ antibodies in combination with ABO-incompatibility with (more than 5,000 MFI) can result in acute antibody mediated rejection. DQ antibodies with MFI less than 5,000 would need close posttransplant monitoring for rebound increase of antibodies.