Clinical relevance of human leukocyte antigen antibodies in kidney transplantation from deceased donors: The North Italy Transplant program approach

At the North Italy Transplant Program (NITp) Reference Center, which is responsible for pre- and posttransplant immunological evaluation and organ allocation, the sera of patients who enter the kidney waiting list are analyzed with complement dependent cytotoxicity (CDC) and a microbead array technique (Luminex). At present, the NITp Waiting list includes 2543 patients. The rate of patients with a percentage panel-reactive antibody (PRA) >= 30 with CDC is about 8%; among them, 1% exhibits a %PRA >= 85. Furthermore, 14% of patients have antibodies detectable only with Luminex. The overall 5-year graft survival in the period 1997-2008 is 85%, whereas that of individuals with a CDC %PRA >= 30 is 80.1% (p = 0.0355). A retrospective analysis oil the effect Of Luminex-detected anti-human leukocyte antigen (HLA) antibodies has Suggested that there is a posttransplant immunological response in Luminex-positive patients that call slowly produce kidney damage. Here we present the NITp current policy for the screening and identification of anti-HLA antibodies in relation to kidney allocation algorithm and the authors' view oil some aspects of discussion. (C) 2009 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.