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Previous Volume 357:1293-1300 September 27, 2007 Number 13 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Flegel, W. A. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Good HLA-A, HLA-B, and HLA-DR matches do not guarantee rejection-free renal transplantation. Some kidney transplants fail despite such matches, suggesting that other antigens might be targets for rejection. Major-histocompatibility-complex (MHC) class I–related chain A (MICA) antigens are polymorphic and can elicit antibody production. We sought to determine whether an immune response to MICA antigens might play a role in the failure of kidney allografts.

Methods Pretransplantation serum samples from 1910 recipients of kidney transplants from deceased donors were tested for anti-MICA antibodies with an assay in which single MICA antigens were attached to polystyrene microspheres.

Results Antibodies against MICA alleles were detected in 217 of the 1910 patients (11.4%). The presence of MICA antibodies was associated with renal-allograft rejection. The mean (±SE) 1-year graft-survival rate was 88.3±2.2% among recipients with anti-MICA antibodies as compared with 93.0±0.6% among recipients without anti-MICA antibodies (P=0.01). Among recipients of first kidney transplants, the survival rate was even lower among MICA antibody–positive patients (87.8±2.4%) than among MICA antibody–negative recipients (93.5±0.6%, P=0.005). In addition, the association of MICA sensitization with reduced graft survival was more evident in kidney-transplant recipients with good HLA matching: among 326 recipients who received well-matched kidneys (0 or 1 HLA-A plus HLA-B plus HLA-DR mismatch), sensitization against MICA was associated with poorer allograft survival (83.2±5.8% among those with anti-MICA antibodies vs. 95.1±1.3% among those without such antibodies, P=0.002).

Conclusions Presensitization of kidney-transplant recipients against MICA antigens is associated with an increased frequency of graft loss and might contribute to allograft loss among recipients who are well matched for HLA.

Source Information

From the Transplantation Immunology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (Y.Z., P.S.); and the Department of Transplantation Immunology, University of Heidelberg, Heidelberg, Germany (C.S., B.D., G.O.).

Address reprint requests to Dr. Stastny at the Transplantation Immunology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8886, or at peter.stastny{at}utsouthwestern.edu.

Full Text of this Article

Related Letters:

Kidney-Transplant Rejection and Anti-MICA Antibodies
Kamoun M., Grossman R. A., Baid-Agrawal S., Frei U. A., Dragun D., Scornik J., Meier-Kriesche H.-U., Stastny P., Zou Y., Opelz G.
Extract | Full Text | PDF  
N Engl J Med 2008; 358:195-196, Jan 10, 2008. Correspondence

This article has been cited by other articles:

• Gebel, H. M., Bray, R. A. (2008). Approaches for transplanting the sensitized patient: biology versus pharmacology. Nephrol Dial Transplant 0: gfn108v1-gfn108 [Full Text]  
• Jevnikar, A. M., Mannon, R. B. (2008). Late Kidney Allograft Loss: What We Know about It, and What We Can Do about It. CJASN 3: S56-S67 [Abstract] [Full Text]  
• Kamoun, M., Grossman, R. A., Baid-Agrawal, S., Frei, U. A., Dragun, D., Scornik, J., Meier-Kriesche, H.-U., Stastny, P., Zou, Y., Opelz, G. (2008). Kidney-Transplant Rejection and Anti-MICA Antibodies. NEJM 358: 195-196 [Full Text]  
• Flegel, W. A. (2007). Will MICA Glitter for Recipients of Kidney Transplants?. NEJM 357: 1337-1339 [Full Text]