Kidney graft recipients with pretransplantation HLA class I antibodies and high soluble CD30 are at high risk for graft loss

In the present study, we investigated whether pretransplantation HLA class I and class II antibodies and pretransplantation levels of soluble CD30 (sCD30) and IgA anti-Fab autoantibodies are predictive of kidney allograft survival. Pretransplantation sera of 504 deceased-donor kidney recipients were tested for IgG HLA class I and class II antibodies, sCD30, and IgA anti-Fab levels using the CTS 4 ELISA kit. Kidney graft survival was estimated by Kaplan-Meier method and multivariate Cox regression. Regardless of the presence of HLA class 11 antibodies, recipients with high HLA class I reactivity had tower 1-year graft survival than recipients with tow reactivity (p < 0.01). Recipients with high sCD30 had tower 5-year graft survival rate than those with Low sCD30 (p < 0.01). The sCD30 effect was observed in presensitized and nonsensitized recipients, demonstrated a synergistic effect with HLA class I antibodies (p < 0.001), and appeared to be neutralized in recipients with no HLA class 11 mismatches. IgA anti-Fab did not influence kidney graft survival. Our results indicate that high pretransplantation sCD30 levels and HLA class I positivity increase the risk of kidney graft toss regardless of other factors. Consequently, such determinations should be routinely performed to estimate recipients' risks of graft rejection before transplantation. (c) 2007 American Society for Histocompatibitity and Immunogenetics. Published by Elsevier Inc. All rights reserved.