Clinical Significance Of Anti-HLA And Anti-MICA Antibodies In Renal Allografts By Dynamic Monitoring

Objective The aim of our study is to explore the impact of post-transplant anti-HLA and anti-MICA antibodies on renal allograft function .Methods 31 recipients who were followed up from pre-transplantation and post- transplantation of 1, 3 ,6 ,12 months and 1 year between January 2007 and January 2009. Each patient had one serum sample taken. Anti-HLA and Anti-MICA antibodies were detected by using Flow PRATM beads , Simultaneously, their serum creatinine levels were tested. Then according to clinical data , the impact of HLA and MICA antibodies on renal allograft function was assessed. Results (1)Among 31 patients, the patients of HLA(-)MICA(-) were 18 cases (67%),HLA(-)MICA(+)were 10 cases (23%), HLA(+) MICA(-)were 1 case(3.2%),and HLA(+)MICA(+)were 2 cases(6.8%) by pre- transplantation.(2)26 patients received a dynamic follow-up in 31 case of transplant recepients, in which 21 cases of antibody did not change before and after transplantation.5 cases changed .4 cases of recepients occurred rejection in 5 cases which antibody changed.(3)There were no obvious differences for stored HLA and MICA antibodies between positive and negative in the aspects of sex, blood transfusion history, CDC, cold ischemia time and the use of immunosuppressive agents(P>0.05)(4)After transplantation 5 cases of patients produced new antibodies(NO.3.4.5.13.30)in which 4 cases had rejection.NO3patient produced MICA18(NDSA) after 6 months of transplantation.NO4 patient produced A33 (NDSA)after 6 months of transplantation and produced DR12(DSA),and B50,DQ7,DR11(NDSA)after 2years of transplantation.NO5 patient produced MICA-7(DSA) and MICA-9(NDSA)after 1 year of transplantation.NO13 patient produced MICA-2,27(NDSA) andB42,A37(DSA)after 1 year of transplantatio.NO30 patient produced MICA-2 (NDSA)after 3 months of transplantation (5)there are 2 patients with routine graft nephrectomy in rejection occurred in nine cases of kidney transplantation and 4 cases has new antibody.(6)the type of antibody was more complex for renal transplant nephrectomy patients.(7)While,after transplantation, 26 cases were follow up and the patients of HLA(-)MICA(-) were 15 cases(58%), HLA(-)MICA(+)were 6 cases (23%),HLA(+)MICA(-)were 2 cases(8%),and HLA(+)MICA(+) were 3 cases(11%).The percentage with abnormal serum creatinine in patients with HLA(+)MICA(+)were higher than those with HLA(-)MICA(-) (P<0.05).and the percentage with abnormal serum creatinine in patients with HLA(-)MICA(+)were higher than those with HLA(-)MICA(-)(P<0.05).(8)the levels of creatinine was significantly higher than normal for rejection of renal transplantation patients. Conclusions 1.Not only have antibody or no before transplant, but also important time of follow-up change that de novo antibody created in post transplant It is important to detect specificity and positive value of anti-HLA antibodies and anti-MICA antibody regular follow-up post transplant, to take effective therapy for decreasing the occurrence and development rejection on renal allograft. 2.New antibody geneared after transplantation ,with the transplante time become long ,the renal allograft function could be impaired by the increased tite of antibody and type of antibody. 3.The tite of antibody and serum creatinine was striking high for the patient of HLA and MICA was masc at equal.4.the level of serum creatininewhich patients who happened rejection was striking high and the tite of antibody rise.