Prospective assessment of pre-existing and de novo anti-HLA IgE in kidney, liver, lung and heart transplantation

Jasmin Mucha, Ara Cho, Anna Marianne Weijler, Moritz Muckenhuber, Amun Georg Hofmann, Markus Wahrmann, Andreas Heinzel, Birgit Linhart, Pia Gattinger, Rudolf Valenta, Gabriela Berlakovich, Andreas Zuckermann, Peter Jaksch, Rainer Oberbauer, Thomas Wekerle

Research output: Journal article (peer-reviewed)Journal article


INTRODUCTION: Antibody mediated rejection (ABMR) is a major factor limiting outcome after organ transplantation. Anti-HLA donor-specific antibodies (DSA) of the IgG isotype are mainly responsible for ABMR. Recently DSA of the IgE isotype were demonstrated in murine models as well as in a small cohort of sensitized transplant recipients. In the present study, we aimed to determine the frequency of pre-existing and de novo anti-HLA IgE antibodies in a cohort of 105 solid organ transplant recipients.

METHODS: We prospectively measured anti-HLA IgE antibodies in a cohort of kidney (n=60), liver, heart and lung (n=15 each) transplant recipients before and within one-year after transplantation, employing a single-antigen bead assay for HLA class I and class II antigens. Functional activity of anti-HLA IgE antibodies was assessed by an in vitro mediator release assay. Antibodies of the IgG1-4 subclasses and Th1 and Th2 cytokines were measured in anti-HLA IgE positive patients.

RESULTS: Pre-existing anti-HLA IgE antibodies were detected in 10% of renal recipients (including 3.3% IgE-DSA) and in 4.4% of non-renal solid organ transplant recipients (heart, liver and lung cohort). Anti-HLA IgE occurred only in patients that were positive for anti-HLA IgG, and most IgE positive patients had had a previous transplant. Only a small fraction of patients developed de novo anti-HLA IgE antibodies (1.7% of kidney recipients and 4.4% of non-renal recipients), whereas no de novo IgE-DSA was detected. IgG subclass antibodies showed a distinct pattern in patients who were positive for anti-HLA IgE. Moreover, patients with anti-HLA IgE showed elevated Th2 and also Th1 cytokine levels. Serum from IgE positive recipients led to degranulation of basophils in vitro, demonstrating functionality of anti-HLA IgE.

DISCUSSION: These data demonstrate that anti-HLA IgE antibodies occur at low frequency in kidney, liver, heart and lung transplant recipients. Anti-HLA IgE development is associated with sensitization at the IgG level, in particular through previous transplants and distinct IgG subclasses. Taken together, HLA specific IgE sensitization is a new phenomenon in solid organ transplant recipients whose potential relevance for allograft injury requires further investigation.

Original languageEnglish
Article number1179036
Pages (from-to)1179036
JournalFrontiers in Immunology
Publication statusPublished - 05 Sept 2023


  • Humans
  • Animals
  • Mice
  • Prospective Studies
  • Liver
  • Heart Transplantation
  • Kidney
  • Immunosuppressive Agents
  • Antilymphocyte Serum
  • Immunoglobulin G
  • Lung
  • Immunoglobulin E


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