Blood Levels of Donor-Specific Human Leukocyte Antigen Antibodies After Renal Transplantation: Resolution of Rejection in the Presence of Circulating Donor-Specific Antibody

Abstract

These data suggest that the dominant method of successful transplantation was function of the transplant in the presence of circulating DSA, and they also define the period during which this occurred.

Clinical usefulness of a novel C1q assay to detect immunoglobulin G antibodies capable of fixing complement in sensitized pediatric heart transplant patients

“…Reports correlating MFI values with positive crossmatches and/or clinical outcomes are widely discrepant and centerdependent, with MFIs ranging from 500 to 6,000. 23,[35][36][37][38] Most agree that a CPRA greater than 10% to 20% by any method is a heightened risk for poor outcomes. 39 Our data suggest that there are 2 types of IgG antibody: one that can bind to antigen but not fix complement (IgGϩ/C1q-) and a second that can both bind and fix complement (IgGϩ/ C1qϩ).…”

Monitoring and treating posttransplant human leukocyte antigen antibodies

“…Accommodation is clearly seen in ABO-incompatible transplants [35] and is suggested as a phenomenon responsible for good function in the presence of antibodies. One such study by Higgins et al included the analysis of 24 patients who had HLA antibodies pretransplant, were treated with plasmapheresis Ϯ intravenous immune globulin, and had daily monitoring for HLA antibodies until postoperative day 14 [36]. Of these patients, donorspecific antibodies (DSA) either caused no rejection (12 patients) or caused rejection (10 patients) that resolved despite persistence of DSA.…”

Posttransplant HLA Alloreactivity in Stable Kidney Transplant Recipients—Incidences and Impact on Long-Term Allograft Outcomes

“…For ABO-compatible transplantation, there is less published evidence for antibody formation in the absence of graft dysfunction. Some highly sensitized recipients subjected to pretransplant apheresis were found to maintain stable graft function despite postoperative recurrence of donorspecific antibodies (DSA) (15,16). Moreover, in a large protocol biopsy study, Mengel et al (17) found that capillary C4d staining may also occur in stable kidney allografts.…”