engleski

DONOR SPECIFIC ANTIBODY MONITORING AND CLINICAL OUTCOME IN KIDNEY TRANSPLANTATION

PURPOSE: Allograft failure and rejection are associated with the presence of donor specific antibodies (DSA) in the recipient's serum. Detection of low levels of HLA-specific antibodies is enabled by the development of more sensitive methods such as solid phase immunoassays (ELISA, Luminex) and flow cytometry. We analyzed the results of DSA detection by Luminex technique with the clinical outcome after kidney transplantation. MATERIALS AND METHODS: We performed retrospective DSA testing (Immucor) in pre-transplant (day 0) and post-transplant sera samples (1 month) of 35 adult renal allograft recipients in University Hospital Center Rijeka, transplanted between November 2009 and October 2012. In all recipients, the pre-transplant cytotoxicity crossmatch was negative. RESULTS: DSA testing revealed median fluorescence intensity (MFI) >2000 in two sera samples (2.9%), MFI 1000-2000 in two samples (2.9%), MFI 700-1000 in four samples (5.7%), while all other samples were negative. All DSA reactivity was related to the HLA Class II antibodies. Rejection episodes were observed in two patients with positive DSA results in pre-transplant sera (MFI 996 and 6092, respectively). Two patients with DSA positivity in pre-transplant sera (MFI >2000) and negative test result one month after transplantation, rejected the allograft within the first year after transplantation. CONCLUSIONS: DSA reactivity with MFI levels above 2000 in pre-transplant sera can be considered as a predictive factor for allograft rejection. To provide more reliable data, the postransplant monitoring should be performed during a longer follow-up period.

kidney transplantation; donor specific antibodies; Luminex; allograft survival

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