Do xenogeneic anti-HLA-A3 antibody cause antibody-mediated rejection in kidney transplant?

Abstract

Objective: Anti-thymocyte globulin-Fresenius is used for induction treatment in kidney transplantation. The antibody ofrabbit originated against human leukocyte antigen A3 were demonstrated in the serum of patients who used anti-thymocyte globulin-Fresenius. We investigated whether anti-human leukocyte antigen A3 antibodies detected due to anti-thymocyte globulin administration had any effect on patient and allograft survival in short- and long-term follow-up. Methods: Fifty-one patients who underwent kidney transplantation between 2004 and 2014 were included in the study. Twenty-nine patients who underwent transplantation from deceased donors received an induction therapy consisting of anti-thymocyte globulin-Fresenius. Antibodies against the human leukocyte antigen were identified using the LABScreen panel reactive antibody class I/II kits with the Luminex method. The graft function and loss, patient survival, and the presence of acute/chronic rejection were investigated. Results: Anti-human leukocyte antigen A3 antibody was detected in 41.3% of the patients receiving anti-thymocyte globulin induction (P = .001). This antibody disappeared at 234.4 days posttransplant. No difference was found regarding pretransplant and posttransplant sensitization of the patients who had posttransplant anti-human leukocyte antigen A3 positivity. The anti-thymocyte globulin dose and administration period were similar for anti-human leukocyte antigen A3 antibody-positive and -negative patients (P >.05). There was no significant difference between groups in short-term, first year, and long-term results of serum creatinine, estimated glomerular filtration rate, and proteinuria values (P >.05). Conclusion: We demonstrated that xenogeneic anti-human leukocyte antigen A3 antibody could be detected in posttrans-plant serum of patients receiving anti-thymocyte globulin induction independent of the dose and duration. The development of this antibody was independent of the exposure of the patient to pre- and posttransplant sensitizing event or the presence of human leukocyte antigen A3 in the allograft. While this study did not demonstrate the effect of xenogeneic anti-human leukocyte antigen A3 antibody on graft and patient survival, retrospective multicenter cohort studies are needed on this issue