Sensitization Trends After Renal Allograft Failure: What Causes Patients to Become Highly Sensitized?

Abstract

Purpose: There is lack of systematic analyses to help minimize sensitization in renal allograft failures (AF). Some patients remain non sensitized (NS) while others become highly sensitized (HS). Our ongoing study analyzes acute rejection (AR), immunosuppression withdrawal (IW) at AF, allograft nephrectomy (AN), Graft Intolerance syndrome (GIS) and HLA mismatches (MM) in NS and HS renal AF. Methods: Seventy NS patients with AF post initial kidney transplantation (KT) were studied. Panel Reactive Antibody (PRA) methodology changed from T cell Anti Human Globulin for Class I to Luminex® platform for HLA Class I and II during study period. Post AF, two main groups comprising of NS (PRA class I & II≤9%) and HS (PRA Class I or II≥80%) were identified. Epitope based method (http://www.HLAmatchmaker.net) to assess overall immunogenicity of MM for NS and HS is also in progress. Results: Latest PRA testing in these 70 patients after AF revealed 19 (27%) to be NS and 38(54%) becoming HS.Figure: No Caption available.Presence of African American (AA) ethnicity, IW at AF, HLA and DR MM, GIS after AF lead to HS status.Table: No Caption available.All cause AN and AR rates were similar between NS and HS groups. Conclusions: IS withdrawal at AF, HLA MM, GIS after AF and AA ethnicity are risk factors leading to HS status. Sensitization traditionally linked to AN may be an epiphenomenon related to GIS. This merits a prospective study to assess if sensitization can be lessened.