Clinical relevance of pre- and post-transplant HLA antibodies, donor-specific, and nondonor-specific HLA antibodies detected by ELISA in renal transplantation.

Human leukocyte antigen (HLA) antibodies reactive to donor antigens (DSA) and non-donor specific antigens (NDSA) were detected by enzyme-linked immunosorbent assay (ELISA) to determine their impact on long-term graft survival. Among 162 patients who had no pre-transplant HLA antibodies, 5-year graft survival was 87%. There was a significant difference compared with 72% for 18 patients who had pre-transplant HLA antibodies (p=0.031). There was a significant difference in graft survival between patients with pre-transplant NDSA and those without HLA antibodies (p=0.0005), but there was not between patients with pre-transplant DSA and those without HLA antibodies (p=0.615). Among 148 patients who had no post-transplant HLA antibodies, 5-year graft survival was 86%. There was no significant difference compared with 85% for 32 patients who had post-transplant HLA antibodies (p=0.118). There was a significant difference in graft survival between patients with post-transplant DSA and those without HLA antibodies (p=0.006), but there was not between patients with post-transplant NDSA and those without HLA antibodies (p=0.599). In conclusion, pre-transplant NDSA and post-transplant DSA were associated with poor long-term graft survival. For patients who had persistent pre- and post-transplant HLA antibodies, the worst long-term survival could be found. We believe HLA antibody analysis by ELISA is still very useful for transplantation.