Anti-HLA sensitization after kidney allograft nephrectomy: changes one year post-surgery and beneficial effect of intravenous immunoglobulin.
The analysis of anti-HLA sensitization at the time of and following allograft nephrectomy may help clinicians to define better both the indications for nephrectomy and preventive therapeutic strategies. We carried out a retrospective analysis of anti-HLA antibodies in 63 clinically indicated nephrectomies (baseline and three and 12 months after) according to the time elapsed since transplantation (six months) and clinical background. An intervention study included 10 patients without donor-specific antibodies (DSA) at the time of nephrectomy treated with high-dose intravenous immunoglobulin (IVIG) (1.5 g/kg). Early nephrectomies were performed in 15 patients (24%). Among the late nephrectomies, 14 patients (22%) were asymptomatic and 34 (54%) had graft intolerance syndrome (GIS). At baseline, anti-HLA sensitization was significantly lower in the early and late asymptomatic groups than in the GIS group, but increased considerably within the three months following surgery. In the group of 10 patients treated with IVIG, only the number of class I non-DSA increased in the three months after surgery, whereas in the control group (N = 13), all anti-HLA variables increased significantly. All patients undergoing a clinically indicated allograft nephrectomy become highly sensitized within the 12 months after surgery. In patients without DSA before nephrectomy, high doses of IVIG may prevent anti-HLA sensitization.
['Matignon|Marie|M|', 'Leibler|Claire|C|', 'Moranne|Olivier|O|', 'Salomon|Laurent|L|', 'Charron|Dominique|D|', 'Lang|Philippe|P|', 'Jacquelinet|Christian|C|', 'Suberbielle|Caroline|C|', 'Grimbert|Philippe|P|']
D000328:Adult D015331:Cohort Studies D005260:Female D006084:Graft Rejection D006085:Graft Survival D006680:HLA Antigens D006648:Histocompatibility D006801:Humans D016756:Immunoglobulins, Intravenous D007518:Isoantibodies D016030:Kidney Transplantation D008297:Male D008875:Middle Aged D009392:Nephrectomy D011183:Postoperative Complications D014184:Transplantation, Homologous D016896:Treatment Outcome
anti-HLA sensitization allograft nephrectomy preventive strategies