Human Leukocyte Antigen Class II Antibodies and Transplant Outcome

摘要

During recent years, increasing evidence has accumulated that preformed antidonor human leukocyte antigen (HLA) class II antibodies represent significant risk factors for transplant dysfunction and failure. Also, the posttransplant development of anticlass II antibodies is associated with a higher incidence of acute and chronic rejection.In this issue, the report by Issa et al. (15) on "Transplant Glomerulopathy: Risk and Prognosis Relate to Anti-HLA Class II Antibody Levels" describes a pretransplant serum analysis of anticlass II antibodies with solid-phase assays using single HLA antigen-coated flow beads. Their patients had been previously transplanted solely on the basis of a negative T-cell antiglobulin-augmented, complement-dependent cytotoxicity crossmatch, a standard approach during that era. This retrospective study showed that 28% of these patients had pretransplant anticlass II antibodies and approximately one-half of them were donor specific. This group had a higher incidence of transplantglomerulopathy and subsequent graft failure than patients without anticlass II antibodies pretransplant. Higher anticlass II antibody levels were also associated with the presence of CD4 in transplant biopsies: These findings provide further support of the concept that anticlass II antibodies have a detrimental effect on kidney transplant outcome.