Prévalence des anticorps anti-HLA chez les enfants en attente de greffe rénale au CHU de Bordeaux

Abstract : Background: immunological assessment before kidney transplantation (including blood- typing, HLA typing and HLA antibody detection) is key to choose a suitable donor and thus to reduce the risk of rejection. Recent techniques of detection of HLA antibodies are more and more sensitive and enable accurate determination of HLA specificities. We sought to determine prevalence of HLA antibodies detected by bead-based assay in children awaiting a first kidney transplant at Bordeaux University Hospital and to study consequences on access to transplantation. We looked for factors that could promote development of HLA antibodies. Ultimately, we discuss clinical relevance of these antibodies. Methods: in this retrospective observational study, we obtained information on HLA antibody testing results, history of known and suspected sensitizing events in children treated in Bordeaux University Hospital, before they received their first kidney transplant. Results: 37% of the 59 children included in this study are sensitized against HLA antigens. Among them, 14% are highly sensitized. Prevalence of HLA antibodies detected by bead- based assay increases over time. Univariate analysis showed an association between HLA sensitization and history of allergy. There was no association with history of transfusion, infection, dialysis, surgery, autoimmunity or vaccines. Discussion: there is an increase in HLA antibodies detection in children awaiting kidney transplantation, which reduces the number of potential donors. Half of the patients who had HLA antibodies had no history of sensitizing events. We found a correlation between allergy and HLA sensitization. Clinical relevance of HLA antibodies detected by bead-based assays is still a matter of debate, indeed over-detection of HLA antibodies could result in illegitimately denying patients access to transplantation. Progress must be made to differentiate between naturally occurring HLA antibodies and antibodies produced following exposure to alloantigen, to identify antibodies against denatured HLA molecules and to tell which ones can be detrimental to the graft.
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Master Thesis
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Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Tuesday, November 28, 2017 - 4:38:32 PM
Last modification on : Saturday, December 9, 2017 - 1:16:55 AM


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Laura Jouhier. Prévalence des anticorps anti-HLA chez les enfants en attente de greffe rénale au CHU de Bordeaux. Médecine humaine et pathologie. 2017. ⟨dumas-01651111⟩



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