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Finding may help doctors pinpoint likelihood of kidney transplant failure

by Amy Norton, Healthday Reporter

(HealthDay)—Kidney transplant patients who develop a specific type of antibody response may be at particular risk of having the organ fail within a few years, a new study suggests.

Experts said the results could help pinpoint those who are at the highest risk of a transplant failure—and possibly aid in finding a good donor organ for some patients.

“This is a very exciting paper,” Dr. Jacqueline Lappin, a transplant surgeon at Scott & White Healthcare in Temple, Texas, said of the study, which appears in the Sept. 26 issue of the New England Journal of Medicine.

Lappin, who was not involved in the research, said the findings give insight into the specific type of immune response that is dangerous to a donor organ. And that could have implications for patients both before and after a kidney transplant, she added.

For the study, French researchers followed 1,016 patients who received donor kidneys at two Paris transplant centers. They wanted to see whether patients who developed a particular type of antibody against the donor organ would be at increased risk of having the transplant fail in the next few years.

The research focused on so-called anti-HLA antibodies. HLAs are proteins on the surface of white blood cells and other tissues; if a kidney donor’s HLAs do not fully match a recipient’s, the recipient’s immune system will develop anti-HLA antibodies.

But while those antibodies may attack and severely injure the donor kidney in some patients, they may do little to no damage in others—suggesting not all anti-HLA antibodies are bad news.

“What we’ve been grappling with is, what is a ‘relevant’ antibody?” Lappin said.

Based on the new findings, the anti-HLA antibodies that are a problem can be distinguished by whether they bind to an immune system protein called C1q. The 77 patients with C1q-binding antibodies were at much higher risk of having the donor kidney fail, according to the researchers.

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