Living donor renal transplantation in the presence of donor-specific human leukocyte antigen antibody detected by solid-phase assay

Abstract

Presensitization of donor human leukocyte antigens (HLA) demonstrated through a positive crossmatch is detrimental to allograft function and best avoided through donor exclusion. The clinical significance of alloantibody detectable by sensitive solid-phase assay is not completely defined and is the focus of this study. Pretransplant sera from 64 consecutive living-donor renal transplant recipients were screened by enzyme-linked immunosorbent assay (ELISA) and Luminex assays. Results were analyzed for correlation with clinical outcome. Luminex proved more sensitive than ELISA for alloantibody detection, with three identifiable patterns. Twenty-eight patients were antibody negative, 24 had non-donor-specific antibody (non-DSA), and 12 had donor-specific antibody (DSA). The highest number of rejections (n = 4) and graft losses (n = 6) occurred in the antibody-negative group. The non-DSA group had two graft losses, as did the DSA group. The two graft losses in the DSA group were caused by recurrent focal segmental glomerulosclerosis (FSGS) at 35 months and death with a functioning graft at 32 months. Overall, there were no cases of antibody-mediated rejection and allograft function to 4 years was comparable among all three groups. Under our standard immunosuppression protocol and crossmatch criteria for histocompatibility, alloantibody detectable by Luminex was not detrimental to successful living-donor transplantation.