Antibody screening and crossmatching in retransplantation.

Classical immunological dogma stipulates that reexposure to antigen results in an immediate and forceful response by the adaptive immune system. In the context of organ retransplantation this response is influenced by several factors, including antibody specificity of the primary response [1], affinity and isotype of preformed antibody, dose and immunogenicity of the antigen, immune responsiveness and health of the recipient. The pioneering work of Kissmeyer-Nielsen in Europe and Terasaki in the USA in the mid 1960s established that kidney transplants could be rejected hyperacutely by thrombosis of the transplant due to binding of preformed recipient antibody to donor antigen. It is now accepted that the most frequent target antigens in such instances are HLA antigens, coded for by the class I (HLA-A, -B, -Cw) or class II (HLA-DR,-DQ) genes of the major histocompatibility complex. Primary sensitization in transplant recipients usually occurs by one of three routes: blood transfusions, pregnancy and organ transplantation [2]. [ABSTRACT FROM AUTHOR]