Clinical relevance of antibody development in renal transplantation

Abstract

The detection and characterization of anti-HLA antibodies and the clinical impact of their appearance following renal transplantation are areas of immense interest. In particular, de novo development of donor-specific antibodies (DSA) has been associated with acute and chronic antibody-mediated graft rejection (AMR). Recently, methods for antibody detection have evolved remarkably from conventional cell-based assays to advanced solid phase systems. These systems have revolutionized the art of defining clinically relevant antibodies that are directed toward a renal graft. While anti-HLA DSAs have been widely associated with poor graft survival, the role of non-HLA antibodies, particularly those directed against endothelial cells, is beginning to be realized. Appreciation of the mechanisms underlying T cell recognition of alloantigens has generated great interest in the use of synthetic peptides to prevent graft rejection. Hopefully, continued progress in unraveling the molecular mechanisms of graft rejection and posttransplant monitoring of antibodies using highly sensitive testing systems will prove beneficial to immunological risk assessment and early prediction of renal allograft failure.

De Novo Produced Anti-Human Leukocyte Antigen Antibodies Relation to Alloimmunity in Patients with Chronic Renal Failure

“…Anti-HLA antibodies have been considered a risk factor for acute or hyperacute rejection and poor long-term allograft survival (Hyun et al, 2012). HLA alloimmunization is known to be associated with various sensitization events such as pregnancy, blood transfusion, and transplantation (Triulzi et al, 2009;Mehra et al, 2013;Valenzuela et al, 2013). Recent studies have shown that the prevalence of leukocyte antibodies increases with pregnancies, and blood transfusion is also associated with a minor increase in leukocyte antibody prevalence (Middelburg, 2011).…”

Graft microvascular disease in solid organ transplantation

“…As ECs are the primary targets for alloimmune attack following transplantation [42–45], we will focus our discussion on injury to ECs of the microvasculature. We will discuss in detail the mechanisms by which immune cells, antibodies, complement factors, oxidative stress, and immunosuppressive drugs induce EC injury.…”

Importance of Pregnancy Induced Paternal HLA Antibody Production in Transplantation: Review

“…4 Furthermore, they can influence the outcome of cell and organ transplantations. 7 Class I molecules are responsible for the presentation of peptides derived from the inner part of the cell to the CD8 + T cells.…”