ADVERSE PRESENSITIZATION TO RENAL TRANSPLANTS

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Abstract
Sera obtained before transplantation from 52 consecutive [human] renal allograft recipients were tested for antibody-dependent cell-mediated cytotoxicity (ADCC) and for complement-dependent cytotoxic antibodies (CDC). A D locus antigen-defined lymphoblastoid cell panel (B [bone marrow-derived] lymphoblastoid cell panel) was used as targets for the ADCC and a peripheral blood lymphocyte (PBL) panel from 40 donors were used as targets for the CDC. Of the 343 ADCC assays, 118 of 168 performed with pretransplant sera from 24 recipients with early graft loss were positive; 81 of 175 performed with pretransplant sera from 25 recipients with a successful graft outcome were positive (P < 0.01). A significantly greater degree of presensitization to the B lymphoblastoid cell panel was found in the group that lost their grafts as compared to the group with successful grafts (69% vs. 49%, P < 0.001). Sera from all 6 recipients with hyperacute rejection were positive in the ADCC before and after absorption with pooled platelets. Pretransplant CDC results were not predictive of ultimate graft outcome. Utilizing any level of cytotoxicity against the PBL panel as an index of adverse presensitization, no significant correlation between pretransplant CDC results and graft outcome was observed. A prognostic role for ADCC using a B lymphoblastoid cell panel as targets to screen and identify high-risk potential graft recipients was suggested.