• DOI:10.1056/NEJMOA067160
• Corpus ID: 46153285

Antibodies against MICA antigens and kidney-transplant rejection.

@article{Zou2007AntibodiesAM,
  title={Antibodies against MICA antigens and kidney-transplant rejection.},
  author={Yizhou Zou and Peter Stastny and Caner S{\"u}sal and Bernd D{\"o}hler and Gerhard Opelz},
  journal={The New England journal of medicine},
  year={2007},
  volume={357 13},
  pages={
          1293-300
        }
}

• Y. Zou, P. Stastny, +2 authors G. Opelz
• Published 27 September 2007
• Medicine, Biology
• The New England journal of medicine

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.