Research On The Impact Of Posttransplant Anti-HLA Antibodies On Renal Allograft Function

Objective To explore the variation of posttransplant anti-HLA antibodies and the impacts of them on renal allograft function.Mothods In the first part, 57 patients with renal allografts were detected the levels, classes and specialties of HLA antibodies by Flow PRATM beads. According to the different levels of HLA antibodies, patients were divided into HLA antibody-positive (≥10%) group and HLA antibody-negative (<10%) group. Then according to the different classes of the antibodies, the HLA antibody-positive group were divided into patients only with anti-HLA classⅠ(Ⅰ+Ⅱ-), only with anti-HLA classⅡ(Ⅰ-Ⅱ+) and both with anti-HLA classⅠand anti-HLA classⅡ(Ⅰ+Ⅱ+). The clinical datas and serum creatinine (SCr) levels were compared among different groups, and the statistical analysis were conducted to. In the second part, all patients underwent kidney transplantation in our hospital since January 2007 were enrolled. The HLA genotyping were tested in all patients and their donors before transplantation. The levels, classes and specialties of HLA antibodies were detected at 1, 3, 6, 12 months after transplantation and their SCr levels were tested simultaneously. Then the variation of HLA antibodies and the impacts of them on renal allograft function was assessed.Results⑴Among the 57 patients, HLA antibody-positive group were 41 cases (71.9%) and HLA antibody-negative group were 16 cases(28.1%). Among antibody- positive group,Ⅰ+Ⅱ- group andⅠ+Ⅱ+ group were both 3 cases(5.3%), andⅠ-Ⅱ+ group was 10 cases(17.5%). The specialties of anti-HLA classⅠwere A1, A11, A24, A80, B27, B64, and anti-HLA classⅡwere predominantly DR52, DR53, DQ2, DQ4, DQ7. The levels of anti-HLA classⅡwere higher. As far as the interval between transplantation and sample collection this time were concerned, the HLA antibody-positive group were (4.55±0.49) years, while the HLA antibody-negative group were (6.64±3.66) years (P <0.05). With the interval prolonged, the percentage of patients with HLA antibodies was rise. In HLA antibody-negative group, 13 cases (31.7%) had abnormal SCr and the SCr levels were (92.12±4.30)μmol/L. While in antibody-positive group, 13 cases (81.3%) had abnormal SCr and the SCr levels were (191.91±29.99)μmol/L. The differences were significant (P <0.01). InⅠ-Ⅱ+ group, 9 cases (90.0%) had abnormal SCr, and the SCr levels were (182.20±33.31)μmol/L, which were also higher than the antibody-negative group (P<0.05).⑵7 patients were followed up for one year. Among them, 5 patients with no HLA antibody all the while had functioning grafts. The other 2 patients had HLA antibodies after transplantation. Between them, one patient with de novo HLA antibody had functioning graft. The specialty of the antibody was A33 and the level was low. Another presensitized patient had the HLA antibodies of B41, A23, A32, C17, C7 before transplantation and the level was 32.73%. After transplantation, the specialties of the antibodies turned more complex and the levels rised. However, the graft functioned well for satisfised HLA matching.Conclusions The anti-HLA antibodies could emerge after transplantation, which may be donor-specific antibodies (DSA) or non-donor-specific antibodies (NDSA). The renal allograft function could be impaired by these antibodies, especially by anti-HLA classⅡ. The anti-HLA antibodies should be monitored after transplantation and effective therapeutic measures must be taken to remove antibodies.