Proinflammatory events are associated with significant increases in breadth and strength of HLA-specific antibody

Am J Transplant. 2009 Sep;9(9):2136-9. doi: 10.1111/j.1600-6143.2009.02764.x. Epub 2009 Jul 30.


Identification of factors responsible for an increase in the breadth or strength of HLA-specific antibody (HSA) is critical to the continued successful management and transplantation of sensitized patients. A retrospective review of our HLA registry identified 107 patients with known HSA and sufficient information in their electronic patient record to determine the presence or absence of a proinflammatory event. The patients were stratified according to transplant status [sensitized and on the transplant waitlist (n = 65); immunosuppressed recipients of a positive crossmatch (+XM) transplant (n = 42)]. Eighty-three percent of waitlist candidates and 55% of sensitized kidney transplant recipients with a documented proinflammatory event had an associated increase in HSA. Interestingly, among patients with a culture-proven infection, 97% of the waitlist patients and 54.8% of +XM recipients had an associated rise in HSA. Overall, proinflammatory events were associated with a greater increase among waitlist patients than +XM recipients, 5.3-fold [IRR 5.25, (95% CI 4.03-6.85), p < 0.001] versus 2.5-fold [IRR 2.54, (95% CI 1.64-3.95), p < 0.001] increase in HSA. Therefore, sensitized patients known to have an infection or undergoing surgery should be monitored for expansion of HSA.

MeSH terms

  • Aged
  • Antibodies / chemistry*
  • Enzyme-Linked Immunosorbent Assay / methods
  • HLA Antigens / chemistry*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Infections / etiology
  • Inflammation*
  • Kidney Transplantation / methods*
  • Middle Aged
  • Postoperative Complications
  • Registries
  • Retrospective Studies
  • Waiting Lists


  • Antibodies
  • HLA Antigens
  • Immunosuppressive Agents