In 45 patients who received kidney transplants, both homologous and heterologous human
antiglobulins (anti-Ig) and HLA cytotoxic
antibodies have been studied before and after
transplantation and in some cases after
nephrectomy. A similar study has been performed in a control group of 1,019 healthy blood donors and in 130 patients with acute or chronic
glomerulonephritis. After
transplantation, homologous anti-IgG were found in 60% of the patients, as compared with 3.5% in the healthy blood donors and 21% in patients with various forms of
glomerulonephritis. This difference is particularly striking in sera obtained prior to
nephrectomy; the presence of
anti-IgG and cytotoxic
antibodies in the same patient being significantly associated with early transplant failure.
Anti-IgA were found in 75% of the patients with transplants and in 37% of the patients with
glomerulonephritis. There was no relationship between the
anti-IgA and the outcome of the graft. On the other hand, heterologous anti-Ig were unchanged in the three groups investigated. The mechanism of formation of the
anti-IgG is not clear. They are probably
antibodies against antigenic structures of the patient's own
antibodies, previously combined with a soluble
antigen or an
antigen on the transplant that has undergone molecular transformation in the course of this reaction. Their pathogenic role, although not demonstrated, can be strongly suspected, and, in a practical way, screening for the anti-Ig in kidney transplant recipients could be of value as a prognostic test.