[Role of anti-HLA antibodies whether or not they are directed against the donor during chronic renal graft dysfunction].

: The appearance or the persistence of anti-HLA antibodies after transplantation, present in 25 % of kidney transplantation patients, is a risk factor for antibody-mediated chronic rejection and therefore loss of the graft and/or chronic dysfunction of the allograft. Sensitive techniques are now available to detect anti-HLA antibodies and follow their progression. These antibodies have multiple effects, notably with the production of growth factors and cytokines by the endothelium and the induction of vascular disorders of the heart transplant in mice. The risk of developing antibody-mediated chronic rejection likely depends on the antigenic specificity of the anti-HLA antibodies and their capacity to activate the complement. Patient management when these antibodies appear remains to be defined. However, it may be possible to obtain a beneficial effect by modifying the immunosuppressor treatment and/or by starting specific treatment to remove them: plasmapheresis, immunoabsorption, immunoglobulins, rituximab, or steroids.