Post‐Transplant Anti‐HLA Class II Antibodies as Risk Factor for Late Kidney Allograft Failure

The purpose of this study was to prospectively analyze the relationship between the post‐transplant anti‐HLA class I and/or class II panel reactive antibodies and graft failure due to chronic allograft nephropathy (CAN). We studied 512 first kidney recipients transplanted at a single center, with a graft functioning for at least 3 years. A single blood sample was collected from each patient for antibody evaluation. The median posttransplant time after blood collection was 4.4 years and did not differ between patients with (n = 91) or without anti‐HLA antibodies (n = 421). Female gender, pregnancies and blood transfusions were associated with the presence of anti‐HLA class I antibodies. Graft function deterioration was associated with anti‐HLA class II antibodies. Multivariate analysis showed independent association for creatinine levels (RR = 7.5), acute rejection (RR = 2.6), recipient male gender (RR = 3.6) and anti‐HLA class II antibodies (RR = 2.9) and CAN‐associated graft loss. In conclusion, the presence of anti‐HLA class II antibodies conferred a risk for graft loss before a decline in renal function and increased the risk of graft failure in patients who already had a decline in graft function. Thus, anti‐HLA class II antibody monitoring is a useful tool for the management of long‐term kidney recipients. A single‐center analysis of first kidney transplant recipients indicates that those with anti‐class II antibodies experienced a higher risk of graft loss, when the antibodies were detected before decline in renal function, and increased the risk of graft failure in those which already showed a decline in graft function.