ELISA ANTI-HLA ANTIBODY SCREENING IDENTIFIES NON-COMPLEMENT-FIXING ANTIBODIES RESPONSIBLE FOR ACUTE GRAFT-REJECTION - A CASE-REPORT

We report on a kidney transplant recipient experiencing an unexpected early acute vascular graft rejection. Retrospective analysis of patien t serum samples, utilizing a new ELISA HLA screening technique, reveal ed that the rejection crisis acid the subsequent graft loss were due t o a pretransplant donor-specific pre-sensitization caused by a non-com plement-fixing antibody of IgG2 class. The case illustrates the clinic al significance of non-complement-fixing anti-HLA antibodies. In addit ion it is shown that ELISA methods are suitable for detecting potentia lly harmful donor pre-sensitization in waiting-list patients not detec table by standard lymphocytotoxicity techniques. Hence ELISA could be an alternative to flow cytometry for this purpose. It is concluded tha t screening and cross-matching techniques which detect non-complement- fixing anti-HLA antibodies could improve graft outcome, and should for m part of the immunological monitoring of kidney transplant waiting-li st patients.