Determinación de autoanticuerpos y aloanticuerpos linfocitotóxicos en pacientes candidatos a trasplante renal

Abstract

The crossmatch for the detection of lymphocytotoxic antibodies is a very important requirement in the study of candidates to kidney transplantation. Herein, we report the findings in 97 patients with chronic renal failure and 127 prospective living related donors. The crossmatches included the study of anti-T and anti-B antibodies at 4, 40 and 37°C against donor cells as well as autologous lymphocytes. Furthermore, the sera were treated with dithiotreitol (DTT) to differentiate between IgM, DTT sensitive, and IgG, DTT resistant. The results show that 40.2% of the patients and 16.5% (P < 0.04) of their healthy donors had auto-antibodies. Alloantibodies were detected in 38% of the patients. Most of the sera reacted with B lymphocytes (71.7%) and were defined as IgM (66.7%), although there were also auto and alloantibodies of the IgG class. There was not a significant effect of neither previous transfusions nor pregnancies in the presence of auto or alloantibodies. Patients with autoantibodies had a significantly higher frequency of living related donors with autoantibodies as compared with negative patients (p < 0.00009). Twenty two patients with autoantibodies, that have been transplanted with kidneys from either living related or cadaveric donors, had their grafts functioning up to one year after transplantation. Patients without autoantibodies had good survival rates when transplanted with kidneys from living related donors but only one third had their cadaveric grafts functioning after one year of transplantation. The results emphasize the importance of a complete evaluation of the lymphocytotoxic antibodies present in the sera of candidates to kidney transplantation.