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Background: This study aimed to establish the prevalence and characteristics of anti-HLA in antibody acquired aplastic anemia patients following cessation of antithymocyte globulin therapy and to characterize antibody in terms of epitope specificity., Study Design and Methods: One hundred and fifty multitransfused, untransplanted patients from eight European centers were investigated by serologic methods., Results: Sixty-two percent were antibody positive. Eighteen HLA-Class-I-specific antibodies (15 IgG, 3 IgM) were identified in 13 patients; 13 antibodies were specific for HLA-A epitopes and 5 for HLA-B. Epitope analysis identified significant correlation between serum reactivity and amino acid substitutions associated with HLA-Class-I epitopes. An excess of antibodies to HLA-A1-associated cross-reactive groups was identified. There was no significant difference in antibody frequency in patients taking cyclosporine compared to those who were not., Conclusion: Data suggested a contribution from B cell memory of alloantigens introduced during pregnancy. In some cases, antibody production continued many years after the last transfusion, and although the target varied between individual patients, the antibody to HLA was focused on a few specific Class I epitopes, the majority of which mapped to the HLA-A molecule.

All viable human tissues transplanted from one individual to another are at risk of rejection. The extent of risk depends on the donor HLA-host T cell receptor disparity. Such disparity is now known to involve genetic products coded by both HLA and non-HLA genes. T cell responses to mismatches on transplants are graded: the greater the mismatch the greater the number of clones of T cells responding. Consequently, the more severe the rejection process. Global statistics support this view in that cumulative mismatches at HLA are associated with poorer graft survival. However such studies also suggest that mismatches at different HLA loci vary in potency. The strength of mismatch seems to increase from HLA-A, the weakest, through HLA-B to HLA-DR, the most potent. Analysis of clinical results suggests that the risk associated with HLA mismatches in kidney transplantation dwindles after the first five months post-transplant. Although graft losses tend to occur sporadically thereafter, no major risk associated with HLA mismatches can be discerned. Whether this dwindling impact of HLA mismatches with time post-transplant is a general phenomenon applicable to all transplants, or whether it suggests some form of adaptation of host to graft in kidney transplant recipients alone is a subject for further exploration. Tissues vary widely in their susceptibility to rejection through HLA mismatches.(ABSTRACT TRUNCATED AT 250 WORDS)

We show how to estimate expected waiting time to transplantation and match grade potential for each patient awaiting kidney transplantation on a multicenter waiting list. We predict that some easily well-matched patients may be unlikely to receive a well-matched graft through accepting an earlier offer of a poorly matched kidney. Other patients, who are difficult to match, may be unlikely to receive even a poorly matched kidney within a reasonable time.

A procedure for the detection of FcR-blocking alloantibodies is described which uses human B lymphocytes immobilised on plastic by poly-L-lysine. Antibodies which inhibited rosette formation between B lymphocytes or Daudi cells and ox erythrocytes coated with rabbit antibodies (EA) were detected in 10 out of 10 sera containing anti-HLA A2 antibodies and 3 out of 3 sera containing anti-HLA class II antibodies. Inhibition of rosette formation (EAI activity) was mediated by protein G-separated IgG. Analysis of rosette formation using these 13 sera and lymphocytes from 39 donors revealed that the degree of inhibition was bimodal; most sera were either clearly inhibitory or non-inhibitory in the assay. However, there was no correlation between inhibition of rosette formation (EAI activity) and lymphocytotoxicity. Four pairs of sera showed similar patterns of reactivity (r greater than 0.6, p less than 0.01; 2 x 2 chi-square test), and cells from 2 donors showed antithetical reactions with 12 of 13 sera (r = -0.86, p less than 0.001). These data suggest that the solid-phase rosette inhibition assay is a rapid and reproducible means of detecting antibodies reactive with non-HLA class I or class II antigens on human B cells.

Highly sensitized patients tend to accumulate on renal transplant waiting lists. A long period of time is often needed for the identification of a compatible graft possessing the rare HLA antigens against which these patients are not immunized. The aim of this study was to identify factors which could explain the fact that the percentage of highly sensitized patients on the Swiss waiting list is one of the highest in Europe. Although no definite conclusion is possible, it seems that this phenomenon is not related to the fact that many of these patients have received mismatched grafts. It seems rather to result from the relatively high rate of transplantations for non-sensitized versus highly sensitized patients in comparison to what is encountered in other countries. The fact that this probably represents only a relative increase in hypersensitized patients is confirmed by the stability of the absolute number of these patients on the waiting list during recent years.

Many studies have shown long-term benefits of HLA matching in kidney transplantation. By examining rates of graft loss within consecutive posttransplant intervals, using data from the UK Transplant Service, we show that the long-term benefits of HLA matching are due to reduction of the graft failure rate within five months of transplantation. After 5-months, HLA-A,B,DR matching appears to have little impact on graft loss. We suggest that graft losses after 5 months may be attributable to non-HLA targets.

1. One-year graft survival of 218 patients transplanted through the SOS Scheme for highly sensitized recipients was 65%. There was significant improvement in the graft survival of 135 patients transplanted from 1986 to 1988, compared to the 83 patients transplanted from 1984 to 1985 (70% vs 56% at 1 year). 2. Of the 513 patients entered into the SOS Scheme, 218 (42%) received a graft, and of those 218, 179 were transplanted within 1 year. 3. Sex and previous graft history influenced the patient's sensitization status. Males with previously failed grafts and females waiting for their first transplant appeared at greater risk of becoming highly sensitized. 4. HLA matching improved graft survival in highly sensitized patients. The effect of matching was most evident for DR and for HLA-B and DR combined. The effect of matching for HLA-A was minimal. 5. HLA-DR1-positive individuals appeared to be at lower risk of becoming highly sensitized. In addition, DR1-positive highly sensitized patients had superior graft survival compared to DR1 negative recipients.

HLA-A, B, C, DR antigen frequencies and Properdin factor B (Bf) allotypes were studied in a group of 44 patients with rapidly progressive periodontitis. HLA-A9 (A24) was the only antigen with a frequency statistically significantly different from the control population. An increased frequency of HLA-A9 was previously reported in periodontal diseases. Our results in a well characterised group of patients adds to the evidence that HLA-A9 plays a role in the susceptibility to severe periodontitis.

HLA-A and -B antigens were determined in 64 Caucasoid patients with keratoconus. A highly significant increase in the frequency of HLA-B5 was found among the patients. Thus keratoconus is the third eye disease after recurrent herpetic keratitis and Behcet's disease showing an association with HLA-B5.

The aim of our study was to define target determinants other than those coded for by the classical HLA-A, -B, -C or -D loci which were responsible for killing in CML. In one of the families studied, strong evidence was found for the existence of a determinant coded for within the HLA region. CML was restricted to targets carrying the classical HLA-Bw35 and Cw4 determinants but the targets were neither HLA-Bw35 nor Cw4 themselves. We therefore concluded that this new HLA determinant was either the product of a new locus closely associated with HLA-B or that it was a product of the classical HLA-B locus which has not been recognized by serology.

Interleukin 2-dependent alloreactive cytotoxic T cell lines, with activity predominantly directed against the HLA-A2 antigen, have been generated in vitro by stimulating blood mononuclear cells from donors nonimmune to the Epstein-Barr (EB) virus with appropriate numbers of EB virus-transformed B cells from A2-homozygous individuals. Such effector cells were tested against a panel of EB virus-transformed target cell lines all expressing the serologically defined A2 antigen but typed into "common A2" and "variant A2" subgroups on the basis of their recognition by A2-restricted EB virus-specific cytotoxic T cells. "Variant A2" responder cells cocultivated with "common A2"-bearing stimulators gave rise to effector T cell lines which recognized only the "common A2"-bearing subgroup of targets. By contrast, responder cells from A2-negative donors stimulated with "common A2"-bearing cells produced effector T cell lines in which the strong lysis of "common A2"-bearing targets was accompanied by a lower, but still significant, lysis directed against all targets within the "variant A2" subgroup. In both cases, lysis of the target cells was blocked equally well by the anti-A2-specific monoclonal antibody MA2.1 as by the monoclonal antibody W6/32 specific for HLA-A, -B, and -C determinants. This suggests that HLA-A2 molecules possess at least two distinct sets of epitopes capable of inducing alloreactive T cell cytotoxicity: first, epitopes probably associated with T cell-restricting sites, which generate subgroup-specific responses, and second, epitopes shared by all A2 molecules, and perhaps associated with serologically defined sites, which generate "pan A2" group-specific responses.

The potential advantages of automated microscopy for reading tissue typing results are accuracy and speed. A technique which depends on fluorescence emission of both Carboxy fluorescein (CF) in live cells and Propidium Iodine (PI) in dead cells has been developed. Factors which influence the data have been investigated and appropriate mathematical corrections proposed. A practical guide is given in an appendix. In comparison with other methods double fluorescence was shown to be more accurate than single fluorescence when compared with results obtained by visual reading.

We have demonstrated that in more than half of the mixed lymphocyte reactions, proliferative reactions, in which responders were reacted against HLA-D-compatible homozygous typing cells, were significantly greater than zero. These reactions often masked the true HLA-D identity of the cells under test, as was subsequently shown by primed lymphocyte testing.

We have demonstrated that there is a similarity in the distribution of restimulation responses of primed lymphocyte typing (PLT) cells raised between related and unrelated individuals, thus leading to the suggestion that HLA-D is a homogeneous determinant. It is proposed that within HLA a hitherto unrecognized heterogeneous structure may exist that is closely associated with HLA-D and which may give rise to intermediate reactions in primary mixed lymphocyte reactions and PLT.

The application of standard tissue typing techniques to cells other than peripheral blood lymphocytes has been accompanied by the problem of extra reactions. This applies as well to Epstein-Barr virus transformed lymphoblastoid cell lines (LCL) as to leukemic cells and human spleen cells. These extra reactions are attributable to additional antibodies in the typing sera which are not apparent under standard conditions with PBLs. Two types are described: Type 1 extras, which becomes apparent after longer incubation times and are attributed to weak antibodies and type 2 extras which are apparent after shorter incubation times and are attributed to subpopulation specific or differentiation antigens. Technical modifications are proposed by which these extras can be circumvented. They include: Only start typing when cells have been cultured for 2 to 3 days. Remove dead cells by spinning over standard ficoll-hypaque or 11% triosil. Use shorter incubation times. Avoid using sera that give too many type 2 extras. In this way phenotypes can be accurately identified on LCL's obtained from kidney transplant donors and recipients. When LCL's were compared with their matching PBL, HLA phenotypes were concordant in 87% of cases for HLA-A, 90% for HLA-B, 81% for HLA-C and 70% for HLA-DR.

Epstein-Barr (EB) virus-specific cytotoxic T-cell preparations, produced by stimulation in vitro of peripheral blood lymphocytes with the autologous virus-transformed cell line, are HLA-A and B antigen-restricted and, with some donors, show preferential restriction through one or two of the four relevant antigens of the donor's HLA type. It has now been demonstrated that such EB virus-specific cytotoxic T cells may also be reactivated by stimulation with allogeneic virus-transformed cells provided that there is no mismatch of the HLA-A and B antigens between the responder and stimulator cell donors. In particular, virus-transformed cell lines from HLA-homozygous donors HLA-A and B antigen-matched to one of the haplotypes of an HLA-heterozygous responder were shown to reactivate selectively only those EB virus-specific cytotoxic T cells restricted through the HLA-A and B antigens present on the allogeneic stimulating cells. In addition to confirming the polyclonal nature of the HLA-restricted EB virus-specific cytotoxic T-cell response, this new experimental procedure has allowed the production, and subsequent expansion as cell lines dependent upon T-cell growth factor, of those effector cells restricted through the "nonpreferred" HLA antigens that are poorly represented in the response induced by stimulation with autologous virus-transformed cells.

A monolayer absorption technique was used to test the hypothesis that killer cells directed to self HLA-associated minor histocompatibility antigens (H-Y) were divisible into subsets. The results showed that sensitized killer cells, which recognized two combined antigens HLA-A2; H-Y and HLA-B7; H-Y could indeed be divided into two populations. One was directed to HLA-A2; H-Y and the other to HLA-B7; H-Y. These results can be interpreted in the context of the altered self hypothesis. However, when interpreted in the context of the dual recognition hypothesis, they strongly suggest that independant clones of killer T cells exist which are committed to the recognition of self HLA.

At least two different methods using cellular responses have been described for defining the determinants of the HLA-D region: typing with HLA-D homozygous cells and primed LD typing. Primed LD typing cells were generated in one-haplotype-different combinations and grouped on the basis of two or more cells appearing to define the same HLA-D-region-determined PL antigen. Such cells were restimulated with homozygous typing cells for several of the presently known HLA DW clusters. A very strong correlation was noted: PLT cells defining the antigen PL1 were restimulated with homozygous typing cells for DW3, those PLT cells defining the antigen PL2 were restimulated by homozygous typing cells for DW2, and those defining PL5 were restimulated by homozygous typing cells for DW1.

HLA-DR4 frequency was raised in patients with persistent acute arthritis following human parvovirus infection, suggesting that DR4 positive individuals are more susceptible to develop joint complications following human parvovirus infection.