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CLINICAL RELEVANCE OF HLA ANTIBODY (SPECIFICITY AND TITER) AND DONOR SPECIFIC FLOW CYTOMETRY CROSSMATCHES IN SIROLIMUS TREATED RENAL ALLOGRAFT RECIPIENTS.
Ronald Kerman, Ph.D., Ida Fernandez, M.D., Hermangshu Podder, M.D., Richard Knight, M.D., Stephen Katz, M.D., Charles Van Buren, M.D. and Barry Kahan, Ph.D., M.D.. Houston TX, USA, University of Texas Medical School-Houston, 77030, Surgery.

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Renal allograft recips with preTx Flow IgG HLA Ab are at risk for rejxn and recips with HLA Ab and a (+) donor FCXM have rejxn and loss of most grafts. To understand why all grafts are not lost we tested preTx sera from 16 preTx AHG-XM-neg recips with early Ab rejxn for Flow IgG HLA Abs, FCXMs, rejxns and graft loss. All 16 recips had donor specific Flow IgG HLA Ab and (+) donor FCXMs. Rejxns were reversed in 69% (11/16) of recips using PP, OKT-3, thymo and/or IvIG therapy. Pre-Tx sera from 4 failed recips had titers of 1:256, 1:256, 1:512 and 1:1024. In contrast, 8 successful recips had titers of 1:8, 1:8, 1:8, 1:8, 1:16, 1:16, 1:16 and 1:32. While all recips presented with immune contraindications (+ donor IgG HLA Ab and + donor FCXM) those recips with lower preTx HLA Ab titers responded to rejxn therapy. The data suggest that strength of Ab reactivity (titer) is important in identifying immunologicaly high risk Tx recips.