Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 19, Issue 11, Pages 3100-3113Publisher
WILEY
DOI: 10.1111/ajt.15414
Keywords
alloantibody; antibody-mediated (ABMR); clinical research; practice; deceased; donors and donation; health services and outcomes research; histocompatibility; kidney transplantation; nephrology; major histocompatibility complex (MHC); organ procurement and allocation; rejection; risk assessment; risk stratification
Categories
Funding
- KU Leuven [C32/17/049] Funding Source: Medline
- Research Foundation - Flanders [IWT.150199] Funding Source: Medline
- The Research Foundation Flanders (F.W.O.) [1196119N, 1844019N, 1842919N] Funding Source: Medline
- Flanders Innovation & Entrepreneurship agency (VLAIO) [IWT.150199] Funding Source: Medline
Ask authors/readers for more resources
In this cohort study (N = 924), we investigated the evolution and clinical significance of pretransplant donor-specific HLA antibodies (preDSA), detected in the single-antigen beads assay but complement-dependent cytotoxicity crossmatch-negative. Donor specificity of the preDSA (N = 107) was determined by high-resolution genotyping of donor-recipient pairs. We found that in 52% of the patients with preDSA, preDSA spontaneously resolved within the first 3 months posttransplant. PreDSA that persisted posttransplant had higher pretransplant median fluorescence intensity values and more specificity against DQ. Patients with both resolved and persistent DSA had a high incidence of histological picture of antibody-mediated rejection (ABMR(h); 54% and 59% respectively). Patients with preDSA that persisted posttransplant had worse 10-year graft survival compared to resolved DSA and preDSA-negative patients. Compared to cases without preDSA, Cox modeling revealed an increased risk of graft failure only in the patients with persistent DSA, in the presence (hazard ratio [HR] = 8.3) but also in the absence (HR = 4.3) of ABMR(h). In contrast, no increased risk of graft failure was seen in patients with resolved DSA. We conclude that persistence of preDSA posttransplant has a negative impact on graft survival, beyond ABMR(h). Even in the absence of antibody-targeting therapy, low median fluorescence intensity DSA and non-DQ preDSA often disappear early posttransplantation and are not deleterious for graft outcome.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available