3.1
#61
NON-SPECIFIC ACTIVATION OF THE IMMUNE SYSTEM CAN PROVOKE ANTI-HLA ANTIBODIES.
Matthew Cooper MD , Andrea A. Zachary, PhD , Julie A. Graziani, CHT , Robert A. Montgomery, MD,PhD and Mary S. Leffell, PhD . Baltimore MD, Johns Hopkins University School of Medicine, 21205-2222, Surgery and Medicine .

Pregnancy, transfusion and transplants are known to provoke anti-HLA antibodies (Abys), but it is not established if physiologic stresses can induce either de novo or recall responses. We evaluated 29 patients who had a sudden rise in allo-Abys following infection, trauma , transfusion or transplant nephrectomy. ELISA was used to screen for IgG, HLA specific Abys. Specificity and PRA were determined by ELISA and cytotoxicity. Criterion for inclusion was an increase in ELISA optical density ratio (ODR) > 5. No other known sensitizing event occurred in these patients in the period preceding the observed Aby rise. Aby specificity expanded in 17/22 (77.3%) patients and 8/10 (80%) with known pre-sensitization recalled donor specific Aby. The mean duration of Aby after infections was the shortest observed and was significantly shorter than that provoked by transfusion (5.9 v.s. 20.3 months, P=0.026). Transfusion induced the greatest increase measured either by ODR or PRA. Infection and trauma likely induce anamnestic responses as 17/18 (94.4%) patients had one or more historical, sensitizing factors. These data demonstrate that episodes of physiologic stress, including infection, surgery or trauma, may significantly increase the level and specificity of anti-HLA antibodies and should be considered in management of patients awaiting transplantation.

Patient CategoryNMulti-specific Increase N (%)Donor Specific Increase N (%)Mean DIfference ODRMean DIfference Cyto PRAMean Duration (months)
Infection147/8 (87.5)3/3 (100)12.2 ± 7.827.4 ± 30.35.9 ± 4.4
Nephrectomy53/5 (60)5/5 (100)13.4 ± 5.726.6 ± 30.98.8 ± 6.5
Transfusion65/6 (83.3)NA15.0 ± 10.342.6 ± 35.320.3 ± 14.0
Trauma42/3 (66.6)1/2 (50)8.7 ± 5.1NA8.5 ± 6.2