THE SIGNIFICANCE OF THE IGG ANTI-B-CELL CROSS-MATCH ON RENAL-TRANSPLANT OUTCOME

Transplantation in the presence of anti-class I antibodies usually res ults in allograft hyperacute rejection. Because of the perception of i ts uncertain clinical significance, B-cell crossmatch which identifies presence of anti-class II antibodies is not universally performed. In a retrospective study, the clinical course of renal transplant recipi ents with IgG anti-B-cell antibodies was analyzed and compared with ca se control patients transplanted contemporaneously, matched demographi cally and immunologically. The incidence of hyperacute, acute, and chr onic rejection as well as graft loss were significantly higher in the group with anti-IgG B-cell antibodies compared to the control. We conc lude that anti-B-cell IgG antibodies are harmful to allografts with a spectrum of events that include hyperacute, acute, vascular and chroni c rejection. While allografts were successful in some patients, our ex perience suggests caution whenever anti-donor B-cell IgG is present. I f transplants are performed, then more potent immunosuppression should be used.