THE HLA-ABCDRDQDP ANTIBODY PROFILE IN RESPONDERS: IS THERE SUPPORT FOR THE CONCEPT OF THE HIGH-RISK TABOO MISMATCH?

摘要

A conundrum, for the histocompatibility professional, is the fact that almost half of the 5 and 6 HLA-ABDR mismatched (MM) renal transplants continue to function for a decade, while better HLA-ABDR "matched" organs are rejected. Almost two decades ago, this observation was addressed by the hypothesis that a particular MM, on a particular host background, impacts graft survival. The terms permissible, immunogenic and taboo were applied to HLA MMs that correlated with a statistical difference in renal allograft survival when large databases were examined, retrospectively. It is also likely that IgG antibody to the HLA-C, -DQ, and/or -DP antigens impacts survival. In this report, the solid-phase antibody (SPA) profile is used to determine the frequency of reactivity to HLA-ABCDRDQDP and, with the HLA type of the patient, test the concept of the high risk or taboo MM. A finding of anti-HLA-CDQDP supports complete typing of donors.