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ANTI-HLA CLASS II POST-TRANSPLANT ANTIBODIES ARE ASSOCIATED WITH GRAFT LOSS DUE TO CHRONIC ALLOGRAFT NEPHROPATHY.
Erika F. Campos MD 1, Helio Tedesco MD,PhD 1, Jose O. Medina-Pestana MD,PhD 1, Sung I. Park 1 and Maria Gerbase-DeLima MD,PhD 1. 1 Pediatrics, Immunogenetics Division, Federal University of Sao Paulo - UNIFESP, Sao Paulo, SP, Brazil .
This study was designed to evaluate the predictive value of anti-HLA antibodies (Ab) regarding graft loss due to chronic allograft nephropathy (CAN).
First recipients (R) of cadaveric or non HLA-identical donors, with a functioning graft for at least 3 years after transplantation (n=512), were evaluated for the presence of anti-HLA class I and II Ab by PRA-ELISA (One Lambda Inc), and followed from 12 to 23 months.80% of the R received PRED/AZA/CYA. Ab to HLA class I, II and I and II were detected in 3.9, 10.7 and 3.1 % of the R, respectively. Ab positive and negative R did not differ regarding time from Tx to Ab testing, R age and race, type of donor, cold ischemia time, occurrence of delayed graft function, acute rejection, or CMV infection. Female gender, pregnancies and number of pre-Tx blood transfusions were significantly associated with the presence of class I Ab. Doubling of serum creatinine, at the time of Ab determination, in relation to the lowest post-Tx value (delta> 100%) was associated with the presence of class II Ab. CAN associated graft loss was significantly higher (p=0.03, OR-2,89) in class II Ab positive R, or class II plus I Ab, compared to R with only class I Ab or Ab negative. There was no significant difference between R positive for class II and class I + II Ab. Other independent associated factors for graft loss were: delta creatinine >100% at the time of Ab assessment, (p<0.0001, OR: 7.52), acute rejection (p<0.05, OR: 2.62) and R gender (male) (p<0.05, OR: 2.62). In conclusion, graft loss due to CAN is significantly associated with the presence of post-transplant anti-HLA class II but not anti-HLA class I antibodies.