DEVELOPMENT OF CYTOTOXIC ANTIBODIES FOLLOWING RENAL-ALLOGRAFT TRANSPLANTATION IS ASSOCIATED WITH REDUCED GRAFT-SURVIVAL DUE TO CHRONIC VASCULAR REJECTION

We prospectively followed 64 patients who had had no cytotoxic antibod ies prior to first cadaveric renal allograft transplantation for post- transplant antibodies. During a mean follow-up period of 62 months (ra nge 45-92) cytotoxic antibodies developed in 36 patients (56%). Sixtee n grafts were lost due to chronic vascular rejection in the group of p atients who developed antibodies compared to two in those who remained antibody negative, P < 0.01. Renal function was worse in the antibody -positive group, median serum creatinine 215 mu mol/l (131-256) (inter quartile range) versus 111 mu mol/l (98-127) in the antibody-negative group, P = 0.002, and creatinine clearance 39 ml/min (25-55) versus 90 ml/min (55-104), P < 0.001. There were no significant differences in immunosuppressive protocol, HLA-mismatching, blood transfusion history , the number of acute rejection episodes, mean arterial blood pressure , or proteinuria between the groups. The presence of cytotoxic antibod ies predated the classical manifestations of chronic vascular rejectio n. This suggests that humoral mechanisms may play a role in the develo pment of chronic Vascular rejection.