Post-transplant donor-specific antibody production and graft outcome in kidney transplantation: results of 16-year monitoring by flow cytometry.

The use of modern immunosuppressive therapy in kidney transplantation has reduced the occurrence of acute rejection and improved short-term graft survival (1) but has been ineffective to prevent chronic allograft dysfunction, which leads to graft failure (2). Many studies have analyzed the posttransplant production of donor-specific alloantibodies. These have been associated with acute and chronic rejection and with reduced graft survival (3-9). Moreover, antibody production can precede any clinical manifestations of graft dysfunction (6, 8, 10). Therefore, the detection and characterization of donor-specific antibodies has become an important task for histocompatibility laboratories. In our laboratory, monitoring for the development of donor-specific antibodies (DSA) in patients receiving a kidney transplant began in 1990. We first used flow cytometric cross-match and then FlowPRATM beads (One Lambda, Canoga Park, CA, USA) which consist of microbeads coated with purified or recombinant HLA class I and II antigens. Here we report the results of 16-year monitoring of posttransplant DSA development in patients who received a cadaveric donor kidney transplant. We also analyze the impact of DSA production on graft outcome and survival.