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HLA antigens in Kawasaki disease.

Two hundred five patients with Kawasaki disease and 500 normal controls were HLA-typed, using a standard microcytotoxicity test of tissue typing. HLA-BW22 was more common in patients with Kawasaki disease than in normal controls (25.4% instead of 11.8%, corrected P less than .0005). Among subtypes of HLA-BW22 antigen, Kawasaki disease was associated with HLA-BW22J2, which was found specifically in Japanese and not in Caucasians. These facts may suggest that there is a gene controlling the susceptibility to Kawasaki disease and linked with a Japanese-specific HLA antigen.

Child↗

Immunology of kidney transplantation.

Despite the increasing knowledge of antigen recognition, tissue matching, effector mechanisms and immune suppression, rejection of renal transplants remains a major problem. This article reviews some of these problems and discusses HLA matching in cadaveric and live related transplants, pregraft blood transfusion and the immunological evaluation of the potential and transplanted recipient.

Graft Rejection↗

The role of HLA typing in clinical kidney transplants: 30 years later.

In summary, the importance of the MHC to the fate of allografts is undoubted. The practical application of this in terms of sending organs long distances with prolonged ischemia time and uncertainty as to the surgical state of the organs leaves an element of doubt as to where the line should be drawn; perhaps the new data from Los Angeles will enable most organs to be used in a localized population catchment area.

Blood Grouping and Crossmatching↗

[The HLA system. An introduction].

The cellular identity is determined by the cell surface antigens. The recognition of self and non-self in vertebrates is mainly controlled by antigens and coded for by the major histocompatibility complex (MHC). Upon recognition of a foreign antigen, the immune system does not only initiate a reaction with the help of cytotoxic T-cells, phagocytes and humoral antibodies; memory cells are also generated, enabling a very swift and powerful response after repeated exposure to the same foreign antigens. These characteristics, although essential for the survival of the organism in a hostile environment, can markedly limit the life of useful and potentially lifesaving organ transplants.

Graft Rejection↗

Absence of irreversible rejection in the presence of warm anti-donor-HLA class I cytotoxic IgG antibody.

Since the initial presentation by Kissmeyer-Nielsen and colleagues [1966] and later by Patel and Terasaki [1969], it has been accepted that renal transplantation should not be performed in the presence of cytotoxic alloreactive antibodies of the IgG fraction performed at room temperature against HLA Class I [Braun 1989] antigens. Such antibodies are feared to induce hyper-acute or accelerated rejection because of the presence of HLA Class I antigens on kidney cells. For this reason, the microlymphocytotoxicity crossmatch (XM test: recipient serum reacted against donor lymphocytes as surrogate for HLA antigens) is now universally used before transplantation [Ting 1983]. A positive XM performed against the recipient T lymphocyte at room temperature after treatment of recipient serum with dithiothreitol (DTT), an agent that removes immunoglobulin M, denotes the presence of cytotoxic alloreactive IgG antibodies against the potential donor HLA class I antigen. Herein, we present the case of a patient who developed positive XM test of the IgG isotype against HLA Class I of the donor antigens performed at room temperature seven days after she received a kidney allograft from her daughter. Although the development of a positive XM was associated clinically with acute rejection, the patient responded remarkably well to anti-rejection therapy and maintained excellent graft function thereafter. Thus, strategies to identify the role played by the different IgG isotypes determined against HLA Class I antigens and their relation to irreversible rejection are needed to differentiate between those potential kidney recipients who may benefit from kidney transplantation in the presence of innocent warm IgG subclass antibodies reactive against HLA Class I antigens and those patients who may not.

Adult↗

Crossmatching considerations in renal transplantation.

During the year 1993-1994, 73 renal transplant cases have been screened for the presence of anti-HLA antibodies using the standard lymphocytotoxicity assay. Amongst the 9 related transplantations with 100% negative crossmatch 6 were successful. About 8.2% of the patients had a shift from positive to negative crossmatch. It was observed that an increased number of transfusions (ranging from 3 to 21) in males and females yielded negative crossmatches. In females, however, owing to various factors such as pregnancies, parity and infections, varied percentages were observed with different donors. The crossmatches in diabetics and hypertensive patients suggest no particular correlation and probably have no role in the outcome of the assay.

Blood Transfusion↗