HLA Antibodies, Non-HLA Antibodies, and Crossmatch Methods
In the mid-1960s a number of reports were published showing a strong association between reactivity of antibodies in the patient’s pregraft serum with the lymphocytes of the donor (positive crossmatch) and immediate rejection of the renal allograft (hyperacute rejection) (Kissmeyer-Nielsen et al. 1966; Terasaki et al. 1968). This finding meant that performing a crossmatch prior to transplantation was mandatory and a positive crossmatch result was regarded as a strict contraindication to transplantation. At this time it was thought that all lymphocytotoxic antibodies were directed at HLA-A, B, and/or C locus antigens (HLA class I antigens). Since these antigens are found on vascular endothelial cells (Daar et al. 1984), it was reasonable to suppose that they were the cause of the graft failure. Lymphocytotoxic antibodies to antigens other than HLA class I have now been recognized, and their effect on organ grafts is not always deleterious. There is no doubt that an understanding of the various antibody specificities which can be detected in the sera of renal patients is important, particularly if we wish to optimize the chance of transplanting patients with broadly reactive antibodies.
KeywordsRenal Allograft Hyperacute Rejection Antiidiotypic Antibody Lymphocytotoxic Antibody Crossmatch Test
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