Development of non-donor-specific HLA antibodies after kidney transplantation: frequency and clinical implications

Patients undergoing renal transplantation frequently have non-donor-specific HLA antibodies (NDSA). There could be NDSA (e.g. a negative crossmatch in a sensitized patient), or could be donor-specific HLA antibodies (DSA) (e.g., antibody-incompatible transplantation). NDSA levels slowly fall in the first month after transplantation, but in some patients their levels initially rise during a rejection episode with increased synthesis of DSA. This could be due to antibodies binding with shared epitopes on donor-specific and non-donor-specific HLA, or due to non-specific immune upregulation. Further investigation of the levels of NDSA in the context of the levels of DSA and other immunoglobulins will lead to new insights into the control of DSA responses.