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UP REGULATION OF NON DONOR SPECIFIC ANTIBODY AFTER TRANSPLANTATION.
Luz Stamm BSC 1, Anastasio Salazar MD 2, Iwona Galaszkiewicz BSC 1 and Noureddine Berka PhD 1. 1 Tissue Typing Laboratory, Calgary Laboratory Services, Calgary, AB, Canada and 2 Department of Transplantation, Southern Alberta Transplant Program, Calgary, AB, Canada .
The identification of anti HLA antibodies after kidney transplantation has been shown to be a risk factor for graft failure. This risk factor also exists even when no donor specificity is found, contradicting the Clonal Selection Theory. A possible explanation for the inconsistency in this theory is that donor specific antibodies (DSA) are in fact, not detected because the antibodies are bound by the graft. However, even if this is true, it does not explain why the up regulation of antibody production with no specificity to the graft occurs.
During the period of 2004-2005, 82 successive kidney transplants were performed in our centre. Thirty-four patients had previous immunization episodes, and 14 of these had panel reactive antibody (PRA) >10 (10-90%) at the time of the transplant. Five of these patients increased their HLA antibodies after transplant and these were not directed to the current donor graft (non donor specific antibody).
Transplant Recipients Pregnancy Transfusion Previous Graft PRA 10-90% 82 27% 24% 13% 17%
Up regulation of non-DSA is not exceptional, but rather a common occurrence in patients sensitized to HLA antigens especially in patients with previous graft loss. More studies are required to find the impact, if any, this phenomenon has on graft survival. We hypothesize that even if DSA are bound to the graft, this does not solve the inconsistency with the Clonal Selection Theory.