What antibodies are considered in a cadaveric donor?

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From the Guidelines

IgG antibodies to HLA antigens are considered in a cadaveric donor.

Key Considerations

  • The presence of IgG antibodies to HLA antigens is a contraindication to transplantation, as it can lead to hyperacute and/or accelerated rejection 1.
  • The crossmatch identifies recipient anti-donor reactivity that is associated with a poor clinical outcome, and it is necessary to test patient sera for the presence of antibodies to HLA antigens and use these reactive sera in the recipient-donor crossmatch 1.
  • Methods used to test for the presence of alloantibodies should be sensitive and identify clinically relevant IgG antibodies to HLA antigens, such as flow cytometry or a complement-dependent cytotoxicity (CDC) assay 1.
  • A positive flow cytometry or AHG-CDC crossmatch against either T cell or B cell donor targets, using sera with IgG antibodies to HLA antigens, is a contraindication to transplantation 1.
  • More recent evidence suggests that HLA-DQ mismatches are associated with a higher risk of de novo DSA development and graft rejection, and minimizing the likelihood of developing HLA-DQ DSA is likely to translate into significant clinical benefit after kidney transplantation 1.

Testing for Antibodies

  • The historically highest PRA, current, and pretransplant sera should be used in a donor-specific crossmatch to prevent hyperacute and/or accelerated rejection 1.
  • Newer assays, such as ELISA and Flow Bead, can detect IgG antibodies to HLA antigens and are more predictive of posttransplant acute rejection and graft loss than membrane-dependent assays 1.
  • The Flow Bead PRA procedure can detect IgG antibody to HLA antigens in sera that are reported to be non-reactive by ELISA, and is a significant risk factor for post-transplant rejection 1.

From the Research

Antibodies Considered in Cadaveric Donor

The following antibodies are considered in a cadaveric donor:

  • Human leukocyte antigen (HLA) molecules, which may be directed against HLA class I or/and class II antigens 2
  • Donor-specific antibodies (DSAs) detectable by flow cytometry (FC) or solid phase assays (SPA) 3
  • Panel reactive antibodies (PRA) which are measured by enzyme-linked immunosorbent assay (ELISA) 2, 4
  • Anti-HLA antibodies, which can be detected by CDC, FC, or SPA 3, 4

Factors Influencing Antibody Levels

Several factors can influence antibody levels in cadaveric donors, including:

  • Patient reactivity to antigen stimulation, which is the most important factor determining PRA levels 2
  • Sensitization level, which can be measured by %PRA 4
  • Presence of DSAs, which can increase the risk of antibody-mediated rejection (AMR) 3

Clinical Relevance of Antibodies

The clinical relevance of antibodies in cadaveric donors is significant, as they can:

  • Increase the risk of acute rejections and graft loss 2
  • Affect graft survival, with higher PRA levels associated with worse outcomes 5
  • Influence the selection of cadaveric kidney recipients, with patients having high PRA levels tend to remain on the waiting list longer 4

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Significance of panel reactive antibodies in patients requiring kidney transplantation.

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2013

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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