Successful Renal Allografts Across a Positive Cross-Match for Donor B-Lymphocyte Alloantigens

Association of HLA-DR Antibodies and Graft Rejection in Renal Transplantation: Posttransplant Analysis Using the Monoclonal Antibody-Specific Immobilization of Leukocyte Antigens Assay (MAILA)

“…By the introduction of the antigen-specific capture assay MAILA we could demonstrate that the formation of HLA-DR antibodies is significantly more frequent in rejecting patients than in patients without rejection episodes. This is in contrast to previous findings, assessing class II antibodies as enhancing or protective factors for the survival of renal allografts [3,6]. In patients with acute and chronic rejection, the prevalence of HLA-DR alloantibodies did not exceed 69.2% in the present study.…”

“…Since the introduction of a donor-recipient cross-match for HLA class I antibodies prior to surgery hyperacute graft failure has become a rare event, and it is now widely accepted that the induction of HLA class I antibodies after renal transplantation is associated with acute and chronic rejection [2]. In contrast, the clinical significance of preformed anti-HLA class II antibodies has been discussed controversially [3][4][5][6][7][8][9][10][11]. Ghasemian et al [10] reported the case of a re-grafted female patient who suffered from hyperacute rejection when transplanted across a positive B-cell cross-match.…”

“…Conversely, Taylor et al [4] described the case of a renal allograft that survived despite the presence of a donor-specific HLA-DQ IgG antibody causing a positive B-cell cross-match. Furthermore, it has been suggested that B-lymphocyte alloantibodies may exert an enhancing effect on renal graft survival [3,6]. Likewise, the impact of anti-HLA class II antibodies induced after transplantation remains unclear.…”

Role of Ia-Like Products of the Main Histocompatibility Complex in Conditioning Skin Allograft Survival in Man

“…The presence ofpreformed HLA-DR antibodies (in response to transfusions and[or] pregnancy) has not, however, been shown to have an obvious effect upon the fate of transplanted kidneys (28,29). Further detailed studies will be required to clarify this point with particular regard to the possible relationship of HLA-DR antibodies to the beneficial effects of blood tranfusions before transplantation.…”

Interrelationship of Time of Dialysis-Dependent Uremia and Pretransplant Blood Transfusions

“…It is currently fashion able to think of this in terms of an anti-la anti body response to the la antigens coded on B cell surfaces which have been demonstrated in some experimental models to be associated with improved graft survival. Indeed, it has been shown that successful renal transplants can be carried out despite a positive B lymph ocyte crossmatch, with a favorable outcome [3], This concept of anti-la antibody promot ing enhancement, while simple and attractive, must be further viewed with caution since temperature-dependent autoantibodies against B lymphocytes may be detected [9], acute rejec tion responses have been shown to provoke the formation of anti-B cell antibodies [4], thus they are good markers of unfavorable sensiti zation, and hyperacute rejection has been as sociated with anti-B cell antibodies and a posi tive B cell crossmatch [1]. Unfortunately, the animal models that have been used to promote this concept tend to be ones that are biased towards a humoral response favoring pro longed graft survival rather than shortened graft survival, therefore the validity of the animal models used to date is questionable in providing a clear explanation for the mech anism of prolongation by blood transfusions.…”