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HLA ANTIBODIES IN POST-TRANSPLANT RENAL ALLOGRAFT RECIPIENT.
Lorita M. Rebellato, Ph.D., Karlene O. Hewan-Lowe, M.D., Kim P. Briley, B.S. and Carl E. Haisch, M.D.. Greenville NC, USA, Brody School of Medicine at East Carolina University, 27858, Pathology and Laboratory Medicine and Greenville NC, USA, Brody School of Medicine at East Carolina University, 27858, Surgery.

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Background: Anti-HLA antibodies have been associated with late graft loss and they also precede renal allograft rejection. We investigated the incidence and role of post-transplant HLA antibodies in rejection and graft failure.
Methods: 231 patients who received renal allografts between 1999 and 2003 were divided into Group A, no HLA antibody pre-transplant and Group B, HLA antibodies pre-transplant. Immunosuppression was cyclosporine, mycophenolate mofetil, and prednisone. Induction consisted of an antilymphocyte cytolytic agent or IL2 receptor antibody. Pre and post-transplant sera were collected and tested for HLA Class I and II antibodies using the Lambda Antigen Tray, One Lambda. Morphologic features of rejection were classified using the Banff criteria.
Results:

Table 1.

	HLA Ab Absent Pre-Txpt	HLA Ab Present Pre-Txpt
Recipients	106	125
Average Age	45.2	45.7
Females	64 (60.4%)	59 (47%)
Caucasians	43 (40.6%)	42 (33.6%)
African Americans	60 (56.6%)	80 (64%)
First Txpt	106 (100%)	112 (89.6%)
Deceased Donor	30 (28.3%)	56 (44.8%)
Living Related Donor	52 (49%)	52 (41.6%)
Living Unrelated Donor	24 (22.7%)	17 (13.6%)
HLA Ab Post-Txpt	12 (11.3%)	54 (43%)
Ab Mediated Rejection	12 (11.3%)	13 (10.4%)
Chronic Rejection	3 (2.8%)	4 (3.2%)
Graft Failure	4 (3.8%)	9 (7.2%)

Conclusions: Post transplant HLA antibodies are more frequent in presensitized renal allograft recipients. Although antibody mediated rejection seems similar in both groups, graft failure is more common in the sensitized group. The current immunosuppression protocol appears not to affect graft survival in the sensitized group.