Monitoreo de anticuerpos HLA en insuficientes renales crónicos en lista de espera uruguaya para trasplante renal 2005

Nelson Toledo; Adriana Tiscornia; Milka Bengochea; Elena Carretto; Ely Silva; Adriana Cabrera; Doris Abilleira; Martha Sosa; Inés Álvarez

Authors

Nelson Toledo Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Instituto Nacional de Donación y Trasplante de Células, Tejidos y Órganos, Laboratorio de Inmunogenética e Histocompatibilidad, Prof. Agregado
Adriana Tiscornia Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Instituto Nacional de Donación y Trasplante de Células, Tejidos y Órganos, Laboratorio de Inmunogenética e Histocompatibilidad, Asistente
Milka Bengochea Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Instituto Nacional de Donación y Trasplante de Células, Tejidos y Órganos, Laboratorio de Inmunogenética e Histocompatibilidad, Prof. Agregado
Elena Carretto Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Instituto Nacional de Donación y Trasplante de Células, Tejidos y Órganos, Laboratorio de Inmunogenética e Histocompatibilidad, Ex Asistente
Ely Silva Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Instituto Nacional de Donación y Trasplante de Células, Tejidos y Órganos, Laboratorio de Inmunogenética e Histocompatibilidad. Lic. Laboratorio Clínico
Adriana Cabrera Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Instituto Nacional de Donación y Trasplante de Células, Tejidos y Órganos, Laboratorio de Inmunogenética e Histocompatibilidad. Lic. Laboratorio Clínico
Doris Abilleira Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Instituto Nacional de Donación y Trasplante de Células, Tejidos y Órganos, Laboratorio de Inmunogenética e Histocompatibilidad. Lic. Laboratorio Clínico
Martha Sosa Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Instituto Nacional de Donación y Trasplante de Células, Tejidos y Órganos, Laboratorio de Inmunogenética e Histocompatibilidad. Téc. Transfusionista
Inés Álvarez Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Instituto Nacional de Donación y Trasplante de Células, Tejidos y Órganos, Laboratorio de Inmunogenética e Histocompatibilidad. Prof. Director

Keywords:

CHRONIC RENAL FAILURE, KIDNEY TRANSPLANTATION, HLA ANTIGENS

Abstract

Introduction: tests of Human Leucocyte Antigen (HLA), antibodies for patients on the waiting list for renal transplant, are necessary to allocate organs and to define the appropriate immunomodulator treatment that result in the best tranplant survival rates.
Methods: we looked for HLA antobodies in 488 patients on the national waiting list for renal transplant. We defined patients with reactivity > 20% (41 pacients) as immunized, and those with reactivity > 80% (6 patients) as highly immunized, by using the microlymphocitotoxicity technique against a lymphicyte test panel, detecting specificity by ELISA and flow cytometry.
Results and conclusions: we found HLA antibodies class I and class II by ELISA, and identified HLA specificities by flow cytometry: 41 (8.4%) of immunized patients showed HLA antibodies class I and 22 (4.5%) evidenced class II. The most frequently found specificities for these antibodies were : A24, A23, BW6, B44, CW6, CW2, DR8, DR7, DQ2, DQ7.We compared the distribution by age, sex, retransplantation, blood type, previous blood transfusions, time on the waiting list and diagnosis of the immunized population with those non-immunized. We found that in the immunized group most of them are candidates for a second transplant (X2=130,47), have received previous transfusions (X2=119,2) and have been on the waiting list longer(p<0,0001). NO differences were found in the distribution by age, sex or etiological diagnosis of chronic renal failure (CRF), being the non-determined nephropaty and glomerulopathies, the most frequent types. Distribution by blood type showed significant differences: in the immunized group there were more patients belonging to group 0 (X2 =7,9) and less of them belonging to group A (X2 =3,94).

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