Huanca-Laura M, Marino L, Morales-Buenrostro LE

Language: Spanish
References: 11
Page: 132-140
PDF size: 296.63 Kb.

ABSTRACT

Introduction: renal transplantation is affected by various long-term events, one of the main causes of graft loss being antibody-mediated rejection (AMR). These rejection events will occur more frequently the greater the pre-transplant immunological risk, which depends largely on the presence of anti-HLA antibodies (HLAab) directed at the donor due to previous exposure to sensitizing factors. Objectives: to compare the immunological outcomes and graft survival according to exposure to sensitizing factors and the presence of pre-transplant HLAab in transplant patients at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Material and methods: retrospective study of the transplanted population between 2014 and 2015, four groups were formed based on exposure to sensitizing factors and the presence of pre-transplant HLAab. The relevant outcomes to be compared between the four groups were: generation of post-transplant donor-specific antibodies (DSA), acute rejections, graft loss and patient death. Results: 135 transplanted patients; the patients with pre-transplant HLAab, 50% had persistence of the same, and in the patients without pre-transplant antibodies, 33% generated de novo HLAab with a wider difference to from the third year. The last control shows us that more than 50% of patients with HLAab before transplantation and with exposure to sensitizing factors, have HLAab. The presentation of AMR events among the different subgroups shows more frequency among the groups with pre-transplant HLAab of 37% and 36% with and without exposure to sensitizing factors, respectively, and even in the group with exposure to sensitizing factors and without HLAab 24%. Groups with HLAab before transplantation, regardless of exposure to sensitizing factors, show a tendency to lower graft survival, although it does not reach statistical significance (p = 0.067). Conclusions: the negative impact of the presence of HLAab pre-transplantation, independent of exposure to sensitizing factors, is shown. Therefore, the measurement of HLAab pre-transplantation is useful for the adequate stratification of the immunological risk.

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