Kidney graft failure and presensitization against HLA class I and class II antigens

Transplantation. 2002 Apr 27;73(8):1269-73. doi: 10.1097/00007890-200204270-00014.


Background: It is well known that kidney transplant recipients with preformed lymphocytotoxic antibodies against HLA antigens have an increased graft rejection rate. However, the individual contribution of anti-HLA class I and class II antibodies to this phenomenon is poorly understood. We investigated the clinical relevance of preformed anti-HLA class I and class II antibodies on graft outcome in more than 4000 kidney recipients.

Methods: Pretransplant sera of 4136 cadaver kidney recipients from 28 transplant centers were tested in ELISA for IgG-anti-HLA class I and IgG-anti-HLA class II antibodies. The influence of antibody reactivity on graft survival was analyzed.

Results: Four hundred eighty of the anti-HLA class I antibody-positive recipients had a graft survival rate at 2 years of 77+/-2%, compared with an 84+/-1% rate in 3656 anti-HLA class I antibody-negative recipients (P<0.0001), and 770 anti-HLA class II-positive recipients had a graft survival rate of 79+/-2%, compared with an 84+/-1% rate in 3366 anti-HLA class II-negative patients (P<0.0001). Importantly, good 2-year graft survival rates of 85+/-3% and 84+/-2%, respectively, were observed in 206 anti-HLA class I-positive/class II-negative and 496 anti-HLA, class I-negative/class II-positive recipients. In contrast, the 274 recipients positive for both types of antibodies showed a poor graft survival rate of 71+/-3% (P<0.0001). Among 853 patients who received a well-matched kidney (0 or 1 HLA-A+B+DR mismatch), sensitization against either class I or class II, or both, had no deleterious effect. However, in 113 class I and class II antibody-positive patients who received a kidney with > or =3 HLA-A+B+DR mismatches, the 2-year graft survival rate was only 60+/-5%.

Conclusion: Presensitization of first kidney transplant recipients against either HLA class I or class II is of no clinical consequence, whereas sensitization against both HLA class I and class II results in increased rejection of HLA mismatched grafts.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Autoantibodies / immunology
  • Cadaver
  • Follow-Up Studies
  • Graft Survival / immunology*
  • HLA-A Antigens / immunology
  • HLA-B Antigens / immunology
  • HLA-D Antigens / immunology*
  • HLA-DR Antigens / immunology
  • Histocompatibility Antigens Class I / immunology*
  • Histocompatibility Testing
  • Humans
  • Immunoglobulin G / immunology
  • Kidney Transplantation / immunology*
  • Time Factors
  • Tissue Donors
  • Treatment Failure


  • Autoantibodies
  • HLA-A Antigens
  • HLA-B Antigens
  • HLA-D Antigens
  • HLA-DR Antigens
  • Histocompatibility Antigens Class I
  • Immunoglobulin G