HLA and XXXX : targets of antibody-mediated rejection in heart transplantation.

@entity1 @entity453 @entity1531
BACKGROUND: The goal of this study was to determine whether antidonor antibodies directed against human leukocyte antigen (HLA) or endothelial cells (ECs) expressed antigens, including major histocompatibility complex class I chain-related antigens A ( @entity1531 ) are associated with the diagnosis of antibody-mediated rejection (AMR) in heart transplant recipients. METHODS: We studied posttransplant antidonor HLA antibodies in 168 heart allograft recipients transplanted from October 2001 to December 2005. Among them, there were 37 AMR+ @entity1 and 131 age- and sex- matched AMR- controls. Sera were collected at the time of protocol biopsies and tested for the presence of HLA antibodies. Seventy-two of the 168 @entity1 were genotyped for donor and recipient @entity1531 alleles and were tested for the presence of anti- @entity1531 antibodies. Thirty-one @entity1 who never developed antibodies to HLA or @entity1531 were further tested for anti-EC antibodies. RESULTS AND CONCLUSIONS: Of 37 AMR+ @entity1 , 22 (60%) developed donor-specific antibodies (DSA) to HLA compared with 6 of 131(4%) AMR- @entity1 (P<0.0001). Of the remaining 15 AMR+ @entity1 , 5 had anti-HLA antibodies that were not donor specific and 10 did not show any HLA antibodies. In the subgroup of 72 @entity1 , all 19 AMR+ @entity1 had clearly demonstrable antibodies reactive with donor HLA, @entity1531 or with nondonor-derived ECs, with 30% of them showed antibodies directed to non-HLA antigens. The incidence of transplant @entity453 was significantly higher in @entity1 who had DSA to HLA and @entity1531 compared with @entity1 without DSA.
