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CLASS I AND CLASS II ANTIBODIES IN MULTIPAROUS PRIMARY RENAL TRANSPLANT CANDIDATES DETECTED USING FLOW PRA BEADS.
Matthew C. Katus, MD, Laura M. McNeish, BS and Marilyn S. Pollack, PhD. Lackland AFB TX, USA, Wilford Hall Medical Center, 78236, Dept. of Pathology; San Antonio TX, USA, University Health System, 78229, Histocompatibility and Immunogenetics Lab. and San Antonio TX, USA, University of Texas Health Science Center, 78229, Dept. of Pathology.

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We previously reported several cases of accelerated graft rejection by multiparous women of kidneys sharing mismatched class I antigens with their husbands (Pollack et al., Human Immunology, 1999). Since all those cases were AHG crossmatch negative, we have subsequently considered a husband's immunogenic mismatched class I antigens as unacceptable for deceased donor transplant. Also, since most of the husbands have not been available for typing, we have more sensitively screened all women with a history of multiple pregnancies using sets of Flow PRA beads coated with class I antigens from different individuals. A recent local case of TRALI caused by class II antibodies in a multiparous blood donor has now led us to include the use of Class II PRA beads in our screening protocol. It was surprising that our tests of more than 100 multiparous primary renal transplant candidates with histories of between 2 and 12 pregnancies indicated that the frequency of class II antibodies was just as high as that for class I antibodies, approximately 40% for each. It was also surprising that most of the women who had detectable antibodies (85%) had either Class I antibodies or Class II antibodies but not both and that so many patients with antibodies were identified; the vast majority of patients tested were well over 50 years of age and had not been pregnant for many years. An analysis of the specificities identified and the factors associated with sensitization will be presented.