Rapid Communications

Kidney International (1990) 38, 12–18; doi:10.1038/ki.1990.161

Effects of recombinant human erythropoietin on HLA sensitization and cell mediated immunity

Paul C Grimm1, Levana Sinai-Trieman1, Neal M Sekiya1, Linda S Robertson1, Brenda J Robinson1, Richard N Fine1 and Robert B Ettenger1

1Pediatric Histocompatibility Laboratory and Division of Pediatric Nephrology, UCLA School of Medicine Los Angeles, California, USA

Correspondence: Dr Robert Ettenger, Division of Pediatric Nephrology, A2-331 MDCC, UCLA Medical Center, 10833 LeConte Avenue, Los Angeles, California 90024, USA.

Received 23 March 1990; Revised 20 April 1990; Accepted 24 April 1990.

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Abstract

Effects of recombinant human erythropoietin on HLA sensitization and cell mediated immunity. Highly presensitized patients wait longer for a renal allograft than unsensitized patients and have a poorer allograft survival rate. Repeated blood transfusions have been implicated in the induction and maintenance of sensitization. To determine the effect of recombinant human erythropoietin (rHuEPO) therapy on five transfusion dependent, highly sensitized adolescents on dialysis, we serially measured percentage panel reactive antibody (%PRA) levels, titers of identifiable discrete anti-HLA Class I antibody specificities, and nonspecific indices of cellular immunity before and following initiation of rHuEPO therapy. Although four of the five patients had previously rejected at least one renal allograft, the removal of chronic antigenic stimulation from blood transfusions led to a marked reduction in anti-HLA antibody titers to recognizable private and public specificities (P < 0.001) and a reduction of mean %PRA from 80% to 56% (P < 0.05). Each patient demonstrated a reduction of two or more dilutions to at least two anti-HLA antibody specificities. A control group of five patients matched for age, transfusion dependence and sensitization status demonstrated no change during a comparable time interval. PHA responsiveness decreased significantly in the rHuEPO group whereas autologous and allogenic mixed lymphocyte response, spontaneous blastogenesis and T-cell subsets did not. These data indicate that in highly sensitized dialysis patients rHuEPO may lead to decreased sensitization, shorter waiting time on dialysis and possibly improved allograft survival rates.

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