HLA-specific alloantibodies and renal graft outcome

HLA-specific humoral immunity, as a result of recipient allosensitization, induces hyperacute rejection of allogenic kidney grafts. Cross-match tests are performed to avoid this complication. However, current techniques do not allow determination of HLA-specificity of donor-reactive antibodies in the acute cadaver-donor situation. New methods are described and discussed in this report as well as the alloantibody specificities that are of clinical importance. Alloantibodies not only mediate hyperacute rejection but may also participate in the acute rejection of organ grafts. Clinical associations between early immunological complications, such as acute rejection, in heart, liver and kidney allografted patients and pre-transplantation humoral alloimmunity emphasize the need for proper determination of donor-specific humoral immunity prior to transplantation.