Diagnostic value of anti-hla antibodies at chronic and late acute rejection of kidney transplant

Aim: to analyze the correlations between class-I and class-II anti-HLA antibodies with microvascular inflammation and C4d-staining in cases of late acute and chronic graft rejection. Materials and methods: The study included 108 patients with indicative graft biopsies (with C4d-staining) and detection of anti-HLA antibodies (ELISA). Patients were divided into 3 groups based on pathology pattern: group 1 (n=50) consisted of patients with chronic graft rejection, group 2 included 24 patients with acute graft rejection with microvascular inflammation, group 3 (n=34) was presented by patients with other graft pathology (control group). Results: Anti-HLA antibodies (predominantly class-II anti-HLA) were identified in 70% of patients of group 1, in 62% of patients of group 2 and 29% patients of group 3 (control). The level of class-II anti-HLA antibodies was significantly higher in C4d-positive cases with no difference between its focal or diffuse expression. In 48% and 57% of patients of 1 and 2 groups, respectively both C4d and anti-HLA antibodies were positive and we considered these cases as AMR without subsequent DSA detection. In cases of isolated C4d staining (12% and 35% of cases in 1 and 2 group, respectively) more sensitive methods (LUMINEX) were needed. In C4d-negative cases (22% in group 1 and 29% in control group) single antigen detection of DSA should be performed. Conclusion: Screening of anti-HLA antibody is a first step of DSA detection, but it can be used as an independent method of diagnosis in the presence of biopsy data in some cases.

трансплантация почки, АТ к HLA, С4d-компонент комплемента, антитело-опосредованное отторжение, kidney transplantation, anti-HLA antibodies, С4d, antibody-mediated rejection

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